Simulated Deployment of Percutaneous Transvenous Mitral Annuloplasty Device Into Human Coronary Sinus Vessel

Functional mitral regurgitation (MR) is the consequence of left ventricular dysfunction occurring after ischemic heart disease and often has poor prognosis. Surgical repair and replacement of the mitral valve are currently being used to treat severe functional MR However, the technique carries high mortality rate [1] and is not suitable for patients with comorbidities and advanced age [2]. Recently, a new non-surgical intervention, percutaneous transvenous mitral annuloplasty (PTMA), is emerging as an attractive endovascular alternative that is less invasive, less recovery time, and cost effective. The device is delivered percutaneously into the coronary sinus (CS) vessel and once embedded, it contracts and shortens the septo-lateral distance of the mitral annulus, hence improve MR. However, despite of its feasibility, current clinical trials reported severe adverse events, such as device fracture [3]. The biomechanical interaction between the CS wall and the stent plays a critical role in the outcome of the deployment and the device performance. In this study, we proposed to analyze this interaction by developing Finite Element (FE) models of the CS vessel and the PTMA anchors and analyzing the peak stresses, strains, interaction forces (shear, normal) after the deployment of the proximal and distal anchors into a realistic patient-specific CS model.