Recently a minimally invasive transcatheter mitral repair device, the MitraClip, has emerged as viable method to treat high-risk patients with primary mitral regurgitation (MR). However, whether it is curative for the secondary MR (SMR) was unknown. In the past two months, two clinical trials, MITRA-FR and COAPT trials obtained contradictory findings on the efficacy of MitraClip in heart failure patients with SMR. In addition to the differences in procedure experience and medical treatment, the patient population in two trials appears to have strong implications to outcomes. Therefore, we hypothesized that the efficacy of MitraClip devices on heart failure patients with SMR depends on two factors: 1) the degree of left ventricle (LV) dilation and its ability to remodeling and 2) the severity of MR. To test our hypothesis, four patient groups: mild-moderately dilated LV + moderate MR, mild-moderately dilated LV + severe MR, severely dilated LV + moderate MR, and severely dilated LV + severe MR, will be studied. To accomplish this goal, the following aims are proposed:Aim 1: Development of a computational model of the left heart integrating structural and hemodynamic dynamics. Method: Patient-specific left heart (LH) models including the aortic root, mitral valve, left atrium, mitral-aortic intervalvular fibrosa, and LV myocardium with active contraction, will be constructed from pre-operative cardiac CT images.Endpoint: This fluid-structure interaction (FSI) model will be validated using the pre-operative clinical data from echocardiography.Aim 2: Simulation of MitraClip device implantations and instantaneous changes in biomechanics.Method: Clinical data for 20 heart failure patients (n=5 in each group) with SMR underwent the MitraClip treatments will be obtained from Columbia University Medical Center, NY. FSI simulations of MitraClip implantations will be performed and compared to the clinical data. Endpoint: The instant impact of post-procedural hemodynamics on the stress and strain of LV myocardium will be quantified.Aim 3: Investigation of the longitudinal effect of MitraClip device interaction with the whole left heart. Method: LV remodeling models will be established based on the clinical follow-up data at 6 months, 1 year and 2 years. Endpoint: This model will assess the longitudinal effect of left heart-MitraClip interactions, in order to offer scientific rationale for device implantation strategies and patient screening.
|Program type||Career Development Award|
|Effective start/end date||04/01/2019 → 03/31/2022|