Pre-Operative Modeling of Transcatheter Mitral Valve Replacement in a Surgical Heart Valve Bioprosthesis

Abstract

Obstruction of the left ventricular outflow tract (LVOT) is a common complication of transcatheter mitral valve replacement (TMVR). This procedure can determine an elongation of an LVOT (namely, the neo-LVOT), ultimately portending hemodynamic impairment and patient death. This study aimed to understand the biomechanical implications of LVOT obstruction in a patient who underwent TMVR using a transcatheter heart valve (THV) to repair a failed bioprosthetic heart valve. We first reconstructed the heart anatomy and the bioprosthetic heart valve to virtually implant a computer-aided-design (CAD) model of THV and evaluate the neo-LVOT area. A numerical simulation of THV deployment was then developed to assess the anchorage of the THV to the bioprosthetic heart valve as well as the resulting Von Mises stress at the mitral annulus and the contract pressure among implanted bioprostheses. Quantification of neo-LVOT and THV deployment may facilitate more accurate predictions of the LVOT obstruction in TMVR and help clinicians in the optimal choice of the THV size.

In Silico Analysis of the MitraClip in a Realistic Human Left Heart Model

“…In the case of edge-to-edge mitral valve repair, simulations of the surgical procedure were compared to echocardiography, revealing that the stress in the leaflets after the edge-to-edge suture was reduced [36]. In previous studies, we demonstrated the feasibility of transcatheter mitral valve replacement in the setting of failed annuloplasty band ring [37], surgical bioprosthesis [38], and massive mitral valve calcifications [39]. In computational studies of the MitraClip, Morgan and collaborators concluded that an uneven MitraClip position led to low anterior and posterior leaflet stress with respect to the model with leaflet prolapse and no clip [40].…”