Numerical simulation of transapical off-pump mitral valve repair with neochordae implantation

BACKGROUND: Transapical off-pump mitral valve (MV) repair is a novel minimally-invasive surgical technique, allowing to correct mitral regurgitation (MR) caused by chordae tendineae rupture. While numerical simulation of the MV structure has proven to be useful to evaluate the effects of the MV surgical repair techniques, no numerical simulation studies on the outcomes of transapical MV repair have been done up to now. OBJECTIVE: The purpose of this study is to evaluate the transapical MV repair using finite element modeling and to determine the effect of the neochordal length on the function of the prolapsing MV. METHODS: The reconstruction of the MV geometry based on the patient-specific data was performed. In order to simulate prolapse, chordae inserted into the middle segment of the posterior leaflet (P2) were ruptured. A total of four virtual transapical repairs using neochordae of different length were performed. The function of the MV before and after virtual repairs was simulated. RESULTS: The evaluation of the effect of the neochordal length on post-repair MV function showed that the length of the implanted neochordae has a significant impact on the correction of MR caused by chordae tendineae rupture. CONCLUSIONS: The presented results can improve the understanding of the effects of transapical MV repair.