Abstract 4146970: Comparative Computational Modeling of Mitral Valve Translocation and Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation

Introduction/Background: Secondary mitral valve regurgitation (SMR) results from left ventricular or left atrial remodeling. Conventional surgical repair with restrictive mitral annuloplasty has demonstrated poor durability in randomized trials. We have described a novel surgical approach, mitral valve translocation (MVT) in which a circumferential, frustum-shaped pericardial patch favorably improves the geometry of the mitral apparatus and abolishes MR. To gain a better understanding of MVT, we sought to compare it in a computational model of SMR vs Transcatheter edge-to-edge repair (TEER). Research Questions/Hypothesis: We sought to compare the effect of MVT to transcatheter edge to edge repair (TEER) on valvular function and hemodynamics using computational modeling. Methods: Using an adaptation of a 3D model developed from a patient specifc mitral valve apparatus model, simulations for TEER and MVT were conducted. Pre- and post-procedure hemodynamics including flow rates, pressures, and geometric measurements were extracted. Results/Data: Mitral valve (MV) pansystolic effective orifice area decreased by 72.6% for MVT and 66% for TEER (Table1), while MV minimal regurgitation area went from 25mm 2 in the native valve to 6mm 2 and 9mm 2 for MVT and TEER respectively. Left ventricular ejection fraction was reduced by 15.3% post-MVT and 11% post-TEER. Left atrial end-diastolic volume (EDV) decreased by 11.2% post-MVT and 8.8% post-TEER. Transmitral pressure gradient decreased by 16.7% post-MVT but increased by 600% post-TEER. Left ventricular (LV) diastolic pressure decreased by 17.0% for MVT, compared to a 51.7% reduction for TEER. LV systolic pressure increased by 14.4% post-MVT and 13.2% post-TEER. Systolic pulmonary arterial pressure rose by 3.9% post-MVT and 4.7% post-TEER Conclusion: Both MVT and TEER effectively improved cardiac function in SMR, with MVT showing greater benefits in certain hemodynamic parameters. Future research will focus on developing patient-specific models to optimize surgical outcomes and explore new repair strategies.