| Autor: |
Simonian, Natalie T, Liu, Hao, Vakamudi, Sneha, Pirwitz, Mark J, Gorman, Joseph H, Gorman, Robert C, Sacks, Michael S |
| Zdroj: |
Circulation (Ovid); November 2022, Vol. 146 Issue: Supplement 1 pA15237-A15237, 1p |
| Abstrakt: |
Introduction:The MitraClip for treatment of mitral regurgitation (MR) is a generally safe and effective procedure. However, recent clinical trials have reported contradictory outcomes, and long-term efficacy remains almost completely unknown. Therefore, there is an urgent need for quantitative, patient-specific treatment optimization grounded on a robust understanding of the functional consequences of the MitraClip repair procedure on each patient-specific mitral valve (MV).Methods:Real-time 3D echocardiography images of ten MR patients’ MVs were acquired during the MitraClip procedure. These images were analyzed using our validated noninvasive strain estimation method to compute the pre-operative leaflet strain fields in the circumferential and radial directions. For the post-operative analysis, 3D MitraClip models were implemented in the corresponding size and number in the simulation to directly grasp the MV leaflets at echo-dictated positions.Results:The MV pre-surgical states were highly variable in both geometry and deformation, underscoring the heterogeneity of the MR in the patient population. There were also no consistent post-surgical global or local strain patterns between MVs. However, the pre- and post-surgical strain fields in the same MV were significantly better correlated than random pre- and post-surgical pairs (p < 0.005). This quantitative result implies that the post-surgical state for each patient can be predictedfrom available pre-surgical data-derived modelling.Conclusions:Due to the highly variable pre-surgical state of regurgitant MVs, a patient-specific approach to MitraClip repair is crucial to improving long-term patient outcomes. Moreover, these findings suggest that the post-surgical state can be correlated to, and therefore predicted from, the pre-surgical state, which would lay the foundation for quantitative surgical planning, tailored patient selection, and ultimately, a more durable repair. |
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