Comparative computational analysis of PASCAL and MitraClip implantation in a patient-specific functional mitral regurgitation model. (September 2021)

• Record Type: Journal Article
• Authors: Errthum, Ryan; Caballero, Andrés; McKay, Raymond; Sun, Wei
• Is Part Of: Computers in biology and medicine. Volume 136(2021)
• Publication Date: 2021-09
• Subjects: Edge-to-edge mitral repair -- Finite-element -- Mitral valve -- Percutaneous -- Secondary mitral regurgitation -- Transcatheter; Medicine -- Data processing -- Periodicals; Biology -- Data processing -- Periodicals; 610.285
• DOI: 10.1016/j.compbiomed.2021.104767
• Languages: English
• ISSNs: 0010-4825

Abstract

Abstract: Transcatheter mitral leaflet approximation with MitraClip has proven to be a viable treatment option for heart failure patients with functional mitral regurgitation (MR). PASCAL is a similar clip device, but it has design features that differentiate it from MitraClip. The effects of the different clip designs are largely unknown. In this study, using a patient-specific, mitral valve-left ventricle heart model, we performed finite-element (FE) simulations to provide a head-to-head comparison of the post-operative effects that PASCAL and MitraClip have on mitral valve (MV) geometry and biomechanics in a functional MR patient. The two devices were modeled as approximations of the real devices, and three implantation configurations were simulated for each device. The results showed that for this patient case, PASCAL caused less MV deformation than MitraClip. Additionally, PASCAL implantation reduced the stresses and strains in the MV leaflets compared to pre-repair conditions, while MitraClip implantation caused them to increase. Although complete coaptation was not achieved, both devices improved leaflet coaptation and were viable MR treatment options. The FE simulations in this study can be used to quantify biomechanics involved in clip treatments and improve our understanding of complex interactions between human hosts and percutaneous clip devices. Highlights: PASCAL and MitraClip are both viable treatment options for patients with FMR. Leaflet stress and strain decreases after PASCAL implantation. Leaflet stress and strain increases after MitraClip implantation. Implantation of PASCAL results in less mitral annulus deformation than MitraClip. Post-repair biomechanics depend on implant design, location, and number.