Computational Modeling of the Subject-Specific Effects of Annuloplasty Ring Sizing on the Mitral Valve to Repair Functional Mitral Regurgitation

Surgical repair of functional mitral regurgitation (FMR) that occurs in nearly 60% of heart failure (HF) patients is currently performed with undersizing mitral annuloplasty (UMA), which lacks short- and long-term durability. Heterogeneity in valve geometry makes tailoring this repair to each patien...

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Vydáno v:Annals of biomedical engineering Ročník 51; číslo 9; s. 1984 - 2000
Hlavní autoři: Gaidulis, Gediminas, Padala, Muralidhar
Médium: Journal Article
Jazyk:angličtina
Vydáno: Cham Springer International Publishing 01.09.2023
Springer Nature B.V
Témata:
Animals
Biochemistry
Biological and Medical Physics
Biomedical and Life Sciences
Biomedical engineering
Biomedical Engineering and Bioengineering
Biomedicine
Biophysics
Classical Mechanics
Computer applications
Computer Simulation
Congestive heart failure
Geometry
Heart Failure
Heart Valve Prosthesis
Heart valves
Heterogeneity
Mathematical models
Mitral valve
Mitral Valve - diagnostic imaging
Mitral Valve - surgery
Mitral Valve Insufficiency - diagnostic imaging
Mitral Valve Insufficiency - surgery
Original Article
Patients
Prediction models
Regurgitation
Surgery
Swine
Tethering
Three dimensional models
Vascular implants
Finite element method
Mitral regurgitation
Mitral valve
Computational modeling
Cardiac mechanics
Mitral annuloplasty
ISSN:0090-6964, 1573-9686, 1573-9686
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Shrnutí:Surgical repair of functional mitral regurgitation (FMR) that occurs in nearly 60% of heart failure (HF) patients is currently performed with undersizing mitral annuloplasty (UMA), which lacks short- and long-term durability. Heterogeneity in valve geometry makes tailoring this repair to each patient challenging, and predictive models that can help with planning this surgery are lacking. In this study, we present a 3D echo-derived computational model, to enable subject-specific, pre-surgical planning of the repair. Three computational models of the mitral valve were created from 3D echo data obtained in three pigs with HF and FMR. An annuloplasty ring model in seven sizes was created, each ring was deployed, and post-repair valve closure was simulated. The results indicate that large annuloplasty rings (> 32 mm) were not effective in eliminating regurgitant gaps nor in restoring leaflet coaptation or reducing leaflet stresses and chordal tension. Smaller rings (≤ 32 mm) restored better systolic valve closure in all investigated cases,but excessive valve tethering and restricted motion of the leaflets were still present. This computational study demonstrates that for effective correction of FMR, the extent of annular reduction differs between subjects, and overly reducing the annulus has deleterious effects on the valve.
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ISSN:0090-6964
1573-9686
1573-9686
DOI:10.1007/s10439-023-03219-9