Numerical simulation of transcatheter mitral valve replacement: The dynamic implication of LVOT obstruction in the valve-in-ring case

Salvatore Pasta; Chiara Catalano; Stefano Cannata; Julius M Guccione; Caterina Gandolfo

doi:10.1016/j.jbiomech.2022.111337

Numerical simulation of transcatheter mitral valve replacement: The dynamic implication of LVOT obstruction in the valve-in-ring case

J Biomech. 2022 Nov:144:111337. doi: 10.1016/j.jbiomech.2022.111337. Epub 2022 Oct 4.

Authors

Salvatore Pasta¹, Chiara Catalano², Stefano Cannata³, Julius M Guccione⁴, Caterina Gandolfo³

Affiliations

¹ Department of Engineering, Viale delle Scienze, Università degli Studi di Palermo, Palermo, Italy; Department of Bioengineering Research, IRCCS-ISMETT, Palermo, Italy. Electronic address: salvatore.pasta@unipa.it.
² Department of Engineering, Viale delle Scienze, Università degli Studi di Palermo, Palermo, Italy.
³ Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.
⁴ Department of Surgery, University of California San Francisco, San Francisco, CA, United States.

PMID: 36209656
DOI: 10.1016/j.jbiomech.2022.111337

Abstract

Transcatheter mitral valve replacement (TMVR) has been used for "off-label" treatment when annuloplasty band ring for mitral repair fails. However, the complex anatomy and function of the mitral valve may lead to fatal complications as a result of the left ventricular outflow tract (LVOT) obstruction in TMVR. We report the structural and hemodynamic response of LVOT obstruction resulting from TMVR with the Edwards SAPIEN 3 Ultra (S3) device. We modified the original Living Heart Human Model (LHHM) to account for a failed mitral valve with an annuloplasty band ring and simulated the cardiac beating condition in the setting of S3 device implantation. Findings demonstrated a high dynamic behavior of the newly formed LVOT (neoLVOT) as confined by the displaced mitral valve and the interventricular septum. During the cardiac beat, the neoLVOT area oscillated from a maximum of 472.1 mm² at early systole to the minimum of 183 mm² at end-systole. The profile of both anchoring force and contact pressure revealed that the band ring serves as the anchoring zone while mitral valve is primally displaced by the deployed device. At early systole, computational flow dynamics highlighted hemodynamic disturbances associated with the LVOT obstruction, with a skewed flow towards the septum and a pressured drop of 4.5 mmHg between the left ventricular apex and the neoLVOT region. This study can lead to a more accurate assessment of the risk induced by the LVOT obstruction when stratifying patient anatomic suitability for TMVR.

Keywords: Computational Fluid Dynamic (CFD); Finite Element (FE) analysis; Living heart human model; Transcatheter mitral valve replacement.

Publication types

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

MeSH terms

Cardiac Catheterization / adverse effects
Cardiac Catheterization / methods
Heart Defects, Congenital*
Heart Valve Prosthesis Implantation* / methods
Heart Valve Prosthesis* / adverse effects
Humans
Mitral Valve / surgery
Mitral Valve Insufficiency*
Risk Factors
Treatment Outcome
Ventricular Outflow Obstruction* / etiology
Ventricular Outflow Obstruction* / surgery