In-Vivo Patient-Specific Optimization of Transcatheter-Edge-to-Edge Repair in Mitral Regurgitation

项目摘要 二尖瓣返流（MR）是一种常见且致命的疾病，其特征在于二尖瓣关闭不全， 瓣膜（MV）瓣叶正确接合，允许血液从左心室回流到左心室 中庭MR的病因是复杂多样的，从粘液瘤性变性的， 从瓣膜组织到心肌梗死再到非缺血性心肌病有几种治疗方法， 这些干预措施的有效性仍然不够理想，而且无法预测。其中一 最新的经导管缘对缘瓣叶夹闭技术称为MitraClip 程序（或TEER）。尽管该手术是安全的，但其临床试验的结果，特别是与 与其他手术和治疗方法，一直是高度矛盾的，主要是由于 因此，很明显，治疗选择的预测方法， 考虑到MV形状和变形中的患者特异性变化， 长期患者结局。我们的小组已经开发了一种非侵入性的，基于图像的方法，在体内MV 应变估计，使我们能够直接从临床可用数据中量化MV形状和变形 成像数据。我们以前也证明了这种技术可以用来识别 接受尺寸过小成形环的缺血性MR患者修复有效性的术前预测因素 瓣环成形术然而，我们实验室和其他人以前的工作集中在MR的有限子集上， 患者;为了制定一个全面的治疗选择指南，模拟必须接地 在一个强大的理解改变MV的生物力学状态在整个范围内的MR病因。 此外，MitraClip的高度非生理性局灶应力对即刻 并且MV瓣叶的长期形状和变形仍然几乎完全未知。我们将 此外，开发TEER程序的完全预测有限元模拟，以便 术前直接在患者MV装置的3D模型上测试各种MitraClip场景， 使用我们对MV功能状态的理解来预测每个患者的12个月结局， 配置，并选择最佳选项。因此，在本研究中，我们的目标是（1）建立 MR频谱中MV的术前状态，以及（2）阐明和预测结果 二尖瓣夹系统在二尖瓣瓣叶几何形状、行为和重塑上的作用，以解释并最终 以患者特异性和定量的方式预测这种治疗的结果。

PROJECT SUMMARY Mitral regurgitation (MR) is a prevalent and deadly disease characterized by the inability of the mitral valve (MV) leaflets to coapt properly, permitting backflow of blood from the left ventricle into the left atrium. The etiologies of MR are complex and diverse, ranging from myxomatous degeneration of the valvular tissue to myocardial infarction to non-ischemic cardiomyopathy. Several types of treatment are available, but the efficacy of these interventions remains suboptimal and unpredictable. One of these options is the relatively recent transcatheter edge-to-edge leaflet clipping technique called the MitraClip procedure (or TEER). Though the procedure is safe, its outcomes in clinical trials, particularly compared to other surgical and therapeutic treatments, have been highly contradictory, largely due to the multifactorial nature of MR. Therefore, it is clear that a predictive approach to treatment selection that accounts for patient specific variations in MV shape and deformation is necessary to optimize long- term patient outcomes. Our group has developed a noninvasive, image-based method for in vivo MV strain estimation which allows us to quantify MV shape and deformation directly from clinically available imaging data. We have also previously demonstrated that this technique can be used to identify predictive, presurgical factors of repair efficacy for ischemic MR patients undergoing undersized ring annuloplasty. However, previous work by our lab and others has focused on limited subsets of MR patients; in order to develop a comprehensive treatment selection guide, simulations must be grounded in a robust understanding of the altered MV biomechanical state in the full range of MR etiologies. Furthermore, the effects of the highly non-physiological focal stress of the MitraClip on the immediate and long-term shape and deformation of the MV leaflets remains almost completely unknown. We will additionally develop a fully predictive finite element simulation of the TEER procedure in order to preoperatively test various MitraClip scenarios directly on a 3D model of the patient's MV apparatus, use our understanding of the MV functional state to predict the 12-month outcomes of each configuration, and select the most optimal option. Therefore, in this study, we aim to (1) establish the pre-operative state of the MV across the MR spectrum and (2) elucidate and predict the consequences of the MitraClip on MV leaflet geometry, behavior, and remodeling in order to explain and ultimately predict the outcomes of this treatment in a patient-specific and quantitative manner.