Mitral valve interventions

Impact of abrupt versus gradual correction of mitral and tricuspid regurgitation: a modelling study

EuroIntervention 2019;15:902-911. DOI: 10.4244/EIJ-D-19-00598

John Walmsley
John Walmsley1, PhD; Pierre Squara2, MD; Ulrich Wolfhard3, MD; Richard Cornelussen4, PhD; Joost Lumens1,5, PhD
1. CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; 2. Department of Critical Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine, France; 3. Medtronic GmbH, Meerbusch, Germany; 4. Bakken Research Center, Medtronic plc, Maastricht, the Netherlands; 5. L’Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Université de Bordeaux, Pessac, France

Aims: Correction of mitral and/or tricuspid regurgitation (MR, TR) frequently leads to poor outcomes in the days following intervention. We sought to understand how abrupt correction of MR and TR affects ventricular load and to investigate if gradual correction is beneficial.

Methods and results: MR and TR were simulated using the CircAdapt cardiovascular system model with effective regurgitant orifice (ERO) areas of 0.5 cm2 and 0.7 cm2. Ventricular and atrial contractility reductions to 40% of normal and pulmonary hypertension were simulated. Abrupt and gradual ERO closure were simulated with homeostatic regulation of blood pressure and volume. Abrupt correction of MR increased left and right ventricular fibre stress by 40% and 15%, respectively, whereas TR correction increased left and right ventricular fibre stress by 26% and 19%, respectively. This spike was followed by a rapid drop in fibre stress. Myocardial dysfunction prolonged the spike but reduced its amplitude. Right ventricular fibre stress increased more with pulmonary hypertension and TR. Gradual correction demonstrated no spike in tissue load.

Conclusions: Simulations demonstrated that abrupt ERO closure creates a transient increase in ventricular load that is prolonged by worsened myocardial condition and exacerbated by pulmonary hypertension. Gradual closure of the ERO abolishes this spike and merits clinical investigation.

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innovationmitral regurgitationpreclinical researchspecific closure device/techniquetricuspid disease
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