Beating heart implantation of transventricular artificial cordae: How can access site selection and leaflet insertion improve mitral regurgitation correction?

Luigi Di Micco; Benedetta Biffi; Silvia Schievano; Daniela P Boso; Laura Besola; Alessandro Fiocco; Gino Gerosa; Francesca M Susin; Andrea Colli; Paolo Peruzzo

doi:10.1016/j.medengphy.2022.103773

Beating heart implantation of transventricular artificial cordae: How can access site selection and leaflet insertion improve mitral regurgitation correction?

Med Eng Phys. 2022 Mar:101:103773. doi: 10.1016/j.medengphy.2022.103773. Epub 2022 Feb 11.

Authors

Affiliations

¹ Cardiovascular Fluid Dynamics Laboratory, ICEA Department, University of Padova, Via Loredan 20, Padova, 35131, Italy. Electronic address: luigi.dimicco@dicea.unipd.it.
² University College London, Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom.
³ Cardiovascular Fluid Dynamics Laboratory, ICEA Department, University of Padova, Via Loredan 20, Padova, 35131, Italy.
⁴ University of British Columbia, St Paul's Hospital Department of cardiovascolar surgery, Vancouver, Canada; DSCTV, University of Padova Medical School, Italy.
⁵ DSCTV, University of Padova Medical School, Italy.
⁶ DSCTV, University of Padova Medical School, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

PMID: 35232552
DOI: 10.1016/j.medengphy.2022.103773

Abstract

NeoChord-DS1000-System (NC) and The Harpoon-Mitral-Repair-System (H-MRS) are two trans-apical chordal implantation devices developed for the treatment of degenerative mitral valve (MV) regurgitation (DMR) either if as Fibroelastic-Deficiency (FED), Forma-Frusta (FF), or Barlow (B) presentation. The aim of this study is to evaluate some of the advantages and disadvantages of these two different devices by performing numerical simulation analyses focused on different transventricular access sites in all subsets of DMR presentations. By applying a novel approach for the development of patient-specific MV domains we worked out a set of numerical simulations of the artificial chordae implantation. Different leaflet insertions and ventricle access sites were investigated, and resulting contact-area (CA), tensioning-forces (F) and leaflet's stress (LS) were calculated. The analyses showed that: i) NC-approach maintains low LS when performed with a posterior access site and optimizes the overlap between the leaflets at the systolic peak; ii) H-MRS-system presents better results in case of a more anterior ventricular entry site; however, for FED prolapse large variation of F and LS with respect to NC-approach are found; iii) an accidental contact between artificial sutures and the anterior leaflet may occur when valve function is restored through an excessive anterior access site. Present findings set light on specific technical aspects of transapical off-pump chords implantation, either performed with NC and H-MRS systems and highlight the advantages and disadvantages proper to the two devices. Our study also paves the basis for a systematic application of computational methodology, in order to plan a patient-specific mini-invasive approach thus maximizing the outcomes.

Keywords: Harpoon; Miitral regurgitation; Mitral valve; Mitral valve repair; Neochord; Transapical; ePTFE.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chordae Tendineae / surgery
Heart Valve Prosthesis Implantation* / methods
Humans
Mitral Valve / surgery
Mitral Valve Insufficiency* / surgery
Treatment Outcome