Key result
Transapical neochordae repair in computational models restored leaflet coaptation but increased average and peak stresses in repaired scallops by >40% and >100% compared with baseline.
Why the study?
Quantifying the complex biomechanical interaction between left heart structures and neochordae during transapical mitral valve repair is technically challenging.
Does the number of neochordae and complexity of leaflet prolapse affect left heart dynamics after transapical mitral valve repair in computational models?
Does the number of neochordae and complexity of leaflet prolapse affect left heart dynamics after transapical mitral valve repair in computational models?
In silico modeling of transapical neochordae repair demonstrates significant increases in leaflet stress and anterior chordae tension post-repair, regardless of using three or four sutures.
May inform neochordae optimization in mitral repair simulations; leaves open clinical validation of findings.
Transapical mitral valve repair with neochordae implantation is a relatively new minimally invasive technique to treat primary mitral regurgitation. Quantifying the complex biomechanical interaction and interdependence between the left heart structures and the neochordae during this procedure is technically challenging. The aim of this parametric computational study is to investigate the immediate effects of neochordae number and complexity of leaflet prolapse on restoring physiologic left heart dynamics after optimal transapical neochordae repair procedures. Neochordae implantation using three and four sutures was modeled under three clinically relevant prolapse conditions: isolated P2, multi-scallop P2/P3, and multi-scallop P2/P1. A fluid-structure interaction (FSI) modeling framework was used to evaluate the left heart dynamics under baseline, prerepair, and postrepair states. Despite immediate restoration of leaflet coaptation and no residual mitral regurgitation in all postrepair models, the average and peak stresses in the repaired scallop(s) increased >40% and >100%, respectively, compared with the baseline state. Additionally, anterior mitral leaflet marginal chordae tension increased >30%, while posterior mitral leaflet chordae tension decreased at least 30%. No marked differences in hemodynamic performance, in native and neochordae forces, and in leaflet stress were found when implanting three or four sutures. We report, to our knowledge, the first set of time-dependent in silico FSI human neochordae tension measurements during transapical neochordae repair. This work represents a further step towards an improved understanding of the biomechanical outcomes of minimally invasive mitral valve repair procedures.
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Caballero et al. (2019) studied Primary mitral regurgitation. Transapical mitral valve repair with neochordae implantation vs. Baseline state was evaluated on Left heart dynamics (stresses and chordae tension). Transapical neochordae repair in computational models restored leaflet coaptation but increased average and peak stresses in repaired scallops by >40% and >100% compared with baseline.
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