Numerical Simulations of MitraClip Placement: Clinical Implications
Numerical Simulations of MitraClip Placement: Clinical Implications
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DOI：
10.1038/s41598-019-52342-y
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发表时间：
2019-11-01
影响因子：
4.6
通讯作者：
Kassab, Ghassan S.
中科院分区：
文献类型：
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作者：
Kamakoti, Ramji;Dabiri, Yaghoub;Kassab, Ghassan S.
二尖瓣返流（MR）是美国75岁以上患者中最常见的心脏瓣膜病类型。尽管二尖瓣返流在老年人群中普遍存在，但是，几乎一半的中重度二尖瓣返流患者由于虚弱和其他现有的合并症而拒绝接受传统的心内直视手术。二尖瓣夹系统（MC）是一种通过将MC放置在二尖瓣中心以减少二尖瓣返流的最新经皮方法。目前没有计算机模拟来阐明MC对二尖瓣流体和固体力学的作用。在这里，我们使用的平滑粒子流体动力学（SPH）的方法来研究各种位置放置的MC在二尖瓣和减少MR的影响。SPH是一种基于粒子（无网格）的方法，处理流量通过狭窄的区域相当有效。流体和周围解剖结构的相互作用是通过接触来处理的，因此可以用于研究流体-结构相互作用问题，例如血液流动与周围组织/结构。此方法可作为Abaqus/Explicit解算器的一部分。通过移除附着在二尖瓣特定瓣叶上的靶向腱索开始回流，随后将MC植入物放置在不同位置，从腱索被移除的区域附近开始，并远离该位置向瓣膜中心移动。在所考虑的MC植入物的所有其他位置中，最靠近腱索被移除位置的MC植入物位置显示出最少的二尖瓣夹系统植入后残留MR。这些发现对于根据MR的病因选择MC的位置以优化临床结果具有重要意义。
Mitral regurgitation (MR) is the most common type of valvular heart disease in patients over the age of 75 in the US. Despite the prevalence of mitral regurgitation in the elderly population, however, almost half of patients identified with moderate-severe MR are turned down for traditional open heart surgery due to frailty and other existing co-morbidities. MitraClip (MC) is a recent percutaneous approach to treat mitral regurgitation by placement of MC in the center of the mitral valve to reduce MR. There are currently no computational simulations to elucidate the role of MC on both the fluid and solid mechanics of the mitral valve. Here, we use the Smoothed Particle Hydrodynamics (SPH) approach to study various positional placements of the MC in the mitral valve and its impact on reducing MR. SPH is a particle based (meshless) approach that handles flow through narrow regions quite efficiently. Fluid and surrounding anatomical structure interactions is handled via contact and hence can be used for studying fluid-structure interaction problems such as blood flow with surrounding tissues/structure. This method is available as part of the Abaqus/Explicit solver. Regurgitation was initiated by removing targeted chordae tendineae that are attached to specified leaflets of the mitral valve and, subsequently, MC implants are placed in various locations, starting from the region near where the chordae tendineae were removed and moving away from the location towards the center of the valve. The MC implant location closest to where the chordae tendineae were removed showed the least amount of residual MR post-clip implantation amongst all other locations of MC implant considered. These findings have important implications for strategic placement of the MC depending on the etiology of MR to optimize clinical outcome.