PERSPECTIVE article
Front. Cardiovasc. Med.
Sec. Structural Interventional Cardiology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1665934
CT predicts Intraprocedural Hemodynamics with Computational Fluid Dynamic in TMVR ineligible patients undergoing M-TEER
Provisionally accepted
Johannes Kirchner1*
Muhammed Gerçek1
Hazem Omran1
Mohammad Kassar2
Christoph Gräni2
Fabien Praz2
Felix Rudolph1Volker Rudolph1
Tanja Katharina Rudolph1- 1Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
- 2Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie, Bern, Switzerland
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Background Hemodynamic outcomes in patients undergoing transcatheter mitral edge-to-edge-repair (M-TEER) are difficult to predict. Computational fluid dynamic (CFD) is frequently used in biomedical engineering to simulate blood flow patterns under various conditions. Objectives The authors developed a standardized workflow for individualized CFD analyses to predict postinterventional mitral valve gradients and residual regurgitation following TEER. Methods Twenty patients with severe mitral regurgitation (MR) from two high volume centers underwent full cycle cardiac computed tomography (CT) before intervention. Based on the specific valve morphology, individualized CFD-simulations were performed to calculate MR volumes prior to intervention and estimate hemodynamics after M-TEER. Results CFD-analyses (mean age 80±4 years, 55% male) showed excellent correlation between baseline PISA-based MR volumes, median 40ml (IQR 30-49ml), and CFD-based calculation, median 30ml (IQR 27-54ml; R=0.917; P<0.001), as well as between baseline effective regurgitant orifice area (EROA) assessed in transesophageal echocardiography (TEE) and CFD-measured EROA (R=0.869; P<0.001). After device implantation, correlation between intraprocedural TEE-measured and CFD-estimated residual MR (R=0.949; P<0.001) and EROA (R=0.841; P<0.001) remained robust. Median post-interventional diastolic pressure gradient (TEE) was 2.8mmHg (IQR 1.7-4.0) which was in close correlation with the CFD estimated gradient of 1.4mmHg (IQR 2.3-4.5), R=0.905; P<0.001). Conclusions This is the first study to use a CFD-standardized workflow for MR evaluation in patients undergoing TEER. In the future, CFD-based analyses might serve as a key-diagnostic tool for procedural planning of TEER.
Keywords: Mitral regurgitation, Transcatheter edge-to-edge repair, Computational fluid dynamic, hemodynamic, CT
Received: 14 Jul 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Kirchner, Gerçek, Omran, Kassar, Gräni, Praz, Rudolph, Rudolph and Rudolph. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Johannes Kirchner, jkirchner@hdz-nrw.de
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