Abstract 15237: Alterations in the Human Mitral Valve in-vivo Functional State in Mitraclip Repair

Abstract

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 predicted from 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.