A Computational Pipeline for Patient-Specific Prediction of the Post-operative Mitral Valve Functional State

Abstract

Mitral valve (MV) repair is safer than replacement for mitral regurgitation (MR) treatment, but long-term outcomes remain suboptimal and poorly understood. Moreover, preoperative optimization is complicated due to the heterogeneity of MR presentations and potential repair configurations. We thus developed a patient-specific MV computational pipeline to quantitatively predict the post-repair MV functional state using standard-of-care preoperative imaging data alone. First, we built a finite-element model of the full patient-specific MV apparatus by quantifying the MV chordae tendinae (MVCT) distributions from 5 CT-imaged excised human hearts and incorporating this data with patient-specific MV leaflet geometries and and MVCT origin displacements from preoperative 3D echocardiography. We then calibrated the leaflet and MVCT pre-strains by simulating preoperative MV closure in order to tune the functionally equivalent, patient-specific mechanical behavior. With this fully calibrated MV model, we simulated undersized ring annuloplasty (URA) by modifying the annular displacement to match the applied ring size. In all patient cases, the postoperative geometries were predicted to within 1 mm of the target, and the MV leaflet strain fields demonstrated very good global and local correspondence to results from a previous heavily validated pipeline. Additionally, our model predicted increased postoperative posterior leaflet tethering in a recurrent patient, which is the likely driver of long-term MV repair failure. This pipeline allows us to predict postoperative outcomes using strictly preoperative clinical data, which lays the foundation for quantitative surgical planning, personalized patient selection, and ultimately, more durable MV repairs.