Journal Article

Ring only repair of bileaflet mitral valve prolapse with mitral regurgitation: Insights from computational modeling

Marom, Gil, White Zeira, Adi, Galili, Lee, Raanani, Ehud, Ram, Eilon, Weissmann, Jonathan, Schwammenthal, Ehud

2024

Overview

This study evaluates the efficacy of annuloplasty repair as a standalone procedure for treating bileaflet mitral valve prolapse with mitral regurgitation (MR). Various flexible ring bands for MR of different severities were compared to assess their biomechanical impact and treatment outcomes. Computational beating heart models, based on the Living Heart Human Model, were utilized to simulate annuloplasty repairs. Repairs using bands of varying lengths were modeled on moderate and severe MR cases, considering bileaflet mitral valve prolapse. Key parameters, including regurgitant orifice area (ROA), prolapse severity, coaptation length, leaflet position, and deformation, were computed to compare conditions before and after implantation. Annuloplasty repairs effectively reduced the ROA in both moderate and severe MR cases, achieving complete sealing in selective instances. Additionally, annuloplasty repair corrected bileaflet prolapse, with prolapse severity decreasing as the annular size increased. Successful coaptation was indicated by the expansion of each leaflet’s contact area distribution and percentage in contact with the opposing leaflet. The risk of systolic anterior motion, that may obstruct the left ventricular outflow tract, was minimized, as the anterior leaflet was directed towards the posterior position. In conclusion, annuloplasty repair alone can effectively treat MR when an appropriate band length is selected. It facilitates a significant reduction in ROA, correction of bileaflet prolapse, and improvement in leaflet coaptation. These findings have important clinical implications, potentially offering a less complex surgical treatment avenue and reducing complications in the management of MR.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Annuloplasty / Barlow disease / Bileaflet prolapse / Biomechanics / Cardiovascular disease / Computational modeling / Computer applications / Computer Simulation / Deformation effects / Heart / Heart valves / Humans / Mitral regurgitation / Mitral valve / Mitral Valve - physiopathology / Mitral Valve - surgery / Mitral Valve Annuloplasty - methods / Mitral Valve Insufficiency - physiopathology / Mitral Valve Insufficiency - surgery / Mitral valve prolapse / Mitral Valve Prolapse - physiopathology / Mitral Valve Prolapse - surgery / Mitral valve repair / Models, Cardiovascular / Morphology / Orifices / Regurgitation / Ring-only repair / Surgical techniques / Vascular implants