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

项目总结 摘要二尖瓣返流(Mr)是一种以二尖瓣关闭不全为特征的流行且致命的疾病。 瓣膜(MV)叶适当地粘合，允许血液从左心室回流到左 中庭。MR的病因复杂多样，从粘液瘤样变性到 瓣膜组织从心肌梗死到非缺血性心肌病。几种类型的治疗方法包括 但这些干预措施的效果仍然不是最理想的，也是不可预测的。这其中的一个 OPTIONS是一种相对较新的经导管边缘对边缘叶夹技术，称为MitraClip 程序(或TEER)。虽然手术是安全的，但它在临床试验中的结果，特别是比较 与其他手术和治疗方法相比，一直是高度矛盾的，主要是由于 因此，很明显，治疗选择的预测性方法 考虑到患者在MV形状和变形方面的特定变化是优化长MV所必需的 患者的长期结局。我们团队开发了一种基于图像的非侵入性活体MV方法 应变估计，使我们能够直接从临床上获得的MV形状和变形进行量化 成像数据。我们以前也演示过，这种技术可以用来识别 动脉环过小的缺血性磁共振患者修复效果的预测性、术前因素 环状成形术。然而，我们实验室和其他实验室之前的工作主要集中在MR的有限子集上 患者；为了制定全面的治疗选择指南，模拟必须建立在基础上 对各种MR病因引起的MV生物力学状态的改变有深入的了解。 此外，MitraClip高度非生理性焦点应力对即刻的影响 而MV小叶的长期形状和变形几乎完全未知。我们会 此外，还开发了TEER过程的完全预测性有限元模拟，以便 术前直接在患者的MV器械的3D模型上测试各种MitraClip场景， 使用我们对MV功能状态的了解来预测每种情况下12个月的结果 配置，并选择最优选项。因此，在本研究中，我们的目标是(1)建立 磁共振波谱的术前MV状态和(2)阐明和预测其后果 为了解释MitraClip对MV小叶的几何、行为和重塑的影响，并最终 以患者特定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.