The effects of mitral annular dynamics, and the laceration of the anterior leaflet with transcatheter mitral valve replacements

Abstract

High-risk patients in need of a mitral valve replacement created a demand for percutaneous MV interventions. With no dedicated devices currently on the market, clinicians have resorted to placing transcatheter aortic valves (TAV) into mitral annular calcification (Valve-in-MAC), failing mitral bioprospthetic valves (valve-in-valve), and failing mitral annulaplasty rings (valve-in-ring). Currently, there are no official surgical guidelines, and no quantitative engineering studies have been conducted to better understand performance and risks. Laceration of the anterior mitral leaflet (LAMPOON) is a proposed proactive solution. The first goal of this dissertation includes designing and performing in vitro experiments to evaluate and quantify benefits of LAMPOON on LVOT obstruction and thrombosis. In addition, there is a need to understand the effects of MV annular contraction on its leaflets. To satisfy this need, a secondary goal of this dissertation is to design and validate an MV in vitro model with a dynamically contracting annulus, and then compare leaflet strain between varying contractile states. These goals will provide a more in-depth quantitative assessment of the benefits of laceration of the anterior mitral leaflet with transcatheter mitral valve replacements, better inform procedural guidelines, as well as provide further insight into MV biomechanics and advanced platforms for future MV in vitro studies.