title: Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation.
abstract: Mitral regurgitation is the most prevalent heart valve disease in the western population. When severe, it requires surgical treatment, repair being the preferred option. The edge-to-edge repair technique treats mitral regurgitation by suturing the leaflets together and creating a double-orifice valve. Due to its relative simplicity and versatility, it has become progressively more widespread. Recently, its percutaneous version has become feasible, and has raised interest thanks to the positive results of the Mitraclip(®) device. Edge-to-edge features and evolution have stimulated debate and multidisciplinary research by both clinicians and engineers. After providing an overview of representative studies in the field, here we propose a novel computational approach to the most recent percutaneous evolution of the edge-to-edge technique. Image-based structural finite element models of three mitral valves affected by posterior prolapse were derived from cine-cardiac magnetic resonance imaging. The models accounted for the patient-specific 3D geometry of the valve, including leaflet compound curvature pattern, patient-specific motion of annulus and papillary muscles, and hyperelastic and anisotropic mechanical properties of tissues. The biomechanics of the three valves throughout the entire cardiac cycle was simulated before and after Mitraclip(®) implantation, assessing the biomechanical impact of the procedure. For all three simulated MVs, Mitraclip(®) implantation significantly improved systolic leaflets coaptation, without inducing major alterations in systolic peak stresses. Diastolic orifice area was decreased, by up to 58.9%, and leaflets diastolic stresses became comparable, although lower, to systolic ones. Despite established knowledge on the edge-to-edge surgical repair, latest technological advances make its percutanoues implementation a challenging field of research. The modeling approach herein proposed may be expanded to analyze clinical scenarios that are currently critical for Mitraclip(®) implantation, helping the search for possible solutions.
authors.affiliation: Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.|Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sturla
authors.affiliation: Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Redaelli
authors.affiliation: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Puppini
authors.affiliation: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy. emiliano.votta@polimi.it.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Votta
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D001696:Biomechanical Phenomena; D005260:Female; D020342:Finite Element Analysis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D066230:Patient-Specific Modeling; D013314:Stress, Mechanical; D013536:Suture Techniques; D014463:Ultrasonography; D014945:Wound Healing / Q000502:physiology
keywords: Edge-to-edge; Finite element model; Heart valve biomechanics; Mitraclip; Mitral regurgitation; Mitral valve