3-D Computational Analysis of the Stress Distribution on the Leaflets after Edge-to-Edge Repair of Mitral Regurgitation
Emiliano Votta MSc, Francesco Maisano MD, Monica Soncini PhD, Alberto Redaelli PhD, Franco M. Montevecchi MSc, Ottavio Alfieri MD

Edge-to-edge repair is an effective, recently introduced method to correct mitral insufficiency by suturing the leaflets at the site of regurgitation. However, controversy exists regarding possible consequences on diastolic function of the repaired valve. Durability of the method has not yet been proven, but simulations may be used to predict clinical outcome. The evaluation of stress distribution after valve repair may predict long-term tendency to failure. Systolic stress does not differ in the native as compared to the edge-to-edge repaired valve. On the contrary, the simulation showed a stress distribution in diastole comparable with that observed in systole. Therefore, valve structures are submitted to a double-frequency stress exposure (as if the heart rate were doubled). Overall stress distribution is increased when the edge-to-edge suture is longer, notably in the presence of a dilated annulus.