A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

Caballero, Andrés; Mao, Wenbin; McKay, Raymond G.; Hahn, Rebecca T.; Sun, Wei

doi:10.3389/fphys.2020.00432

Cited by 29 publications

(24 citation statements)

References 88 publications

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“…The PISA method and summation of vena contracta is not reliable in the presence of multiple MR jets created by MC therapy 27 . While 3D TEE imaging enables the operator to measure the vena contracta as well as the EROA directly by 3D planimetry, such measurements can lead to an overestimation after MC therapy 28 . Invasive hemodynamics, which have the advantage of being accurately assessed intraprocedural have advanced to the forefront of this assessment 29,30 .…”

Section: Discussionmentioning

confidence: 99%

Invasive hemodynamics are equivocal for functional outcomes after MitraClip

Power

Reiff

Tsangaris

et al. 2022

Health Science Reports

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Objectives To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes. Background Mitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes. Methods Sixty‐nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's t test was used for continuous variables and Pearson's chi‐squared test for categorical variables. Mann‐Whitney test was performed for continuous variables where data were not normally distributed. Logistic and linear regression were used to investigate relationships between variables and outcomes. Results A total of 69 patients were included in the study. The mean age was 83 (75‐87) years and 38 (55%) were male. Eighty‐one percentage had >/= NYHA III symptoms. Eighty‐seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15‐24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes. Conclusion Left atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.

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Section: Discussionmentioning

confidence: 99%

Invasive hemodynamics are equivocal for functional outcomes after MitraClip

Power

Reiff

Tsangaris

et al. 2022

Health Science Reports

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“…Similar to the previous device, this shortening simulation was done in a diastolic position. Then a surgical suture, which was modelled by truss elements with a cross-section area of 0.074 mm 2 and with material properties of ePTFE [36], was constructed to connect the node groups in the CS and the LV locations of the modified geometries. The suture was connected to the heart with a distributed force coupling to smoothly disperse the tension load.…”

Section: Methodsmentioning

confidence: 99%

Numerical biomechanics modelling of indirect mitral annuloplasty treatments for functional mitral regurgitation

2022

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Mitral valve regurgitation (MR) is a common valvular heart disease where an improper closure leads to leakage from the left ventricle into the left atrium. There is a need for less-invasive treatments such as percutaneous repairs for a large inoperable patient population. The aim of this study is to compare several indirect mitral annuloplasty (IMA) percutaneous repair techniques by finite-element analyses. Two types of generic IMA devices were considered, based on coronary sinus vein shortening (IMA-CS) to reduce the annulus perimeter and based on shortening of the anterior–posterior diameter (IMA-AP). The disease, its treatments, and the heart function post-repair were modelled by modifying the living heart human model (Dassault Systèmes). A functional MR pathology that represents ischaemic MR was generated and the IMA treatments were simulated in it, followed by heart function simulations with the devices and leakage quantification from blood flow simulations. All treatments were able to reduce leakage, the IMA-AP device achieved better sealing, and there was a correlation between the IMA-CS device length and the reduction in leakage. The results of this study can help in bringing IMA-AP to market, expanding the use of IMA devices, and optimizing future designs of such devices.

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“…The SPH method was demonstrated and validated in several articles on mitral valve closure [ 30 , 40 , 41 , 42 ]. Subsequently, it was used to assess several diseased mitral valve states [ 43 , 44 , 45 , 46 ] and applications of medical devices designed to correct them [ 47 , 48 , 49 , 50 ]. Besides the mitral valve, other valves have been studied using the same methods [ 42 , 51 , 52 , 53 , 54 , 55 ].…”

Section: Applicationsmentioning

confidence: 99%

Fluid–Structure Interaction Analyses of Biological Systems Using Smoothed-Particle Hydrodynamics

Toma

Chan-Akeley

Arias

et al. 2021

Biology

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Due to the inherent complexity of biological applications that more often than not include fluids and structures interacting together, the development of computational fluid–structure interaction models is necessary to achieve a quantitative understanding of their structure and function in both health and disease. The functions of biological structures usually include their interactions with the surrounding fluids. Hence, we contend that the use of fluid–structure interaction models in computational studies of biological systems is practical, if not necessary. The ultimate goal is to develop computational models to predict human biological processes. These models are meant to guide us through the multitude of possible diseases affecting our organs and lead to more effective methods for disease diagnosis, risk stratification, and therapy. This review paper summarizes computational models that use smoothed-particle hydrodynamics to simulate the fluid–structure interactions in complex biological systems.

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A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient

Cited by 29 publications

References 88 publications

Invasive hemodynamics are equivocal for functional outcomes after MitraClip

Invasive hemodynamics are equivocal for functional outcomes after MitraClip

Numerical biomechanics modelling of indirect mitral annuloplasty treatments for functional mitral regurgitation

Fluid–Structure Interaction Analyses of Biological Systems Using Smoothed-Particle Hydrodynamics

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