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

John Walmsley, Pierre Squara, Ulrich Wolfhard, Richard Cornelussen, Joost Lumens*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

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 cm(2) and 0.7 cm(2). 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.

Original languageEnglish
Pages (from-to)902-911
Number of pages24
JournalEurointervention
Volume15
Issue number10
DOIs
Publication statusPublished - Nov 2019

Keywords

  • innovation
  • mitral regurgitation
  • preclinical research
  • specific closure device/technique
  • tricuspid disease
  • LEFT-VENTRICULAR FUNCTION
  • VALVE-REPLACEMENT
  • HEART
  • REPAIR
  • PREDICTION
  • SURGERY
  • HYPERTENSION
  • TRABECULAE
  • ADAPTATION
  • MORTALITY

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