title: Design considerations and quantitative assessment for the development of percutaneous mitral valve stent.
abstract: Percutaneous heart valve replacement is gaining popularity, as more positive reports of satisfactory early clinical experiences are published. However this technique is mostly used for the replacement of pulmonary and aortic valves and less often for the repair and replacement of atrioventricular valves mainly due to their anatomical complexity. While the challenges posed by the complexity of the mitral annulus anatomy cannot be mitigated, it is possible to design mitral stents that could offer good anchorage and support to the valve prosthesis. This paper describes four new Nitinol based mitral valve designs with specific features intended to address migration and paravalvular leaks associated with mitral valve designs. The paper also describes maximum possible crimpability assessment of these mitral stent designs using a crimpability index formulation based on the various stent design parameters. The actual crimpability of the designs was further evaluated using finite element analysis (FEA). Furthermore, fatigue modeling and analysis was also done on these designs. One of the models was then coated with polytetrafluoroethylene (PTFE) with leaflets sutured and put to: (i) leaflet functional tests to check for proper coaptation of the leaflet and regurgitation leakages on a phantom model and (ii) anchorage test where the stented valve was deployed in an explanted pig heart. Simulations results showed that all the stents designs could be crimped to 18F without mechanical failure. Leaflet functional test results showed that the valve leaflets in the fabricated stented valve coapted properly and the regurgitation leakage being within acceptable limits. Deployment of the stented valve in the explanted heart showed that it anchors well in the mitral annulus. Based on these promising results of the one design tested, the other stent models proposed here were also considered to be promising for percutaneous replacement of mitral valves for the treatment of mitral regurgitation, by virtue of their key features as well as effective crimping. These models will be fabricated and put to all the aforementioned tests before being taken for animal trials.
authors.affiliation: Institute of High Performance Computing, A*STAR, Singapore 138632, Singapore.
authors.forename: Gideon Praveen
authors.initials: GP
authors.lastname: Kumar
authors.affiliation: Institute of High Performance Computing, A*STAR, Singapore 138632, Singapore. Electronic address: cuifs@ihpc.a-star.edu.sg.
authors.forename: Fangsen
authors.initials: F
authors.lastname: Cui
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore 119074, Singapore.
authors.forename: Hui Qun
authors.initials: HQ
authors.lastname: Phang
authors.affiliation: Department of Bioengineering, National University of Singapore, Singapore 117576, Singapore.
authors.forename: Boyang
authors.initials: B
authors.lastname: Su
authors.affiliation: Department of Bioengineering, National University of Singapore, Singapore 117576, Singapore.
authors.forename: Hwa Liang
authors.initials: HL
authors.lastname: Leo
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore 119074, Singapore.
authors.forename: Jimmy Kim Fatt
authors.initials: JK
authors.lastname: Hon
mesh_terms: D000497:Alloys / Q000737:chemistry; D000818:Animals; D001672:Biocompatible Materials / Q000737:chemistry; D017076:Computer-Aided Design; D055119:Elastic Modulus; D004867:Equipment Design; D019544:Equipment Failure Analysis; D066298:In Vitro Techniques; D008422:Materials Testing; D008943:Mitral Valve / Q000503:physiopathology* / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation* / Q000379:methods; D015607:Stents; D013526:Surgical Mesh; D053441:Suture Anchors; D013552:Swine
chemical_list: D000497:Alloys; D001672:Biocompatible Materials; C013616:nitinol
keywords: Computer aided design; Conceptual design; Crimping; Finite element analysis; Mitral valve stent; Paravalvular leakage