Left Ventricular Remodelling Following Mitral Valve Implantation

One person in four suffers from some form of cardiovascular condition, including high blood pressure, atherosclerosis, coronary artery disease, stroke, rheumatic fever and bacterial endocarditis. Additional conditions or derivatives of the above include congenital heart defects, aortic coarctation and aneurysm formation, cardiac infarction, and cardiac valve deficiency, for which there is a clinical need for intervention by elective surgery. Any one of the heart valves, but predominantly the aortic and mitral valves, may become either so stenotic or regurgitant that it needs to be replaced or repaired in order to restore normal heart function. Regardless of the nature (acquired or congenital) and underlying cause of valvular dysfunction, surgeons are confronted with a difficult decision regarding the choice of optimum replacement prostheses or reconstruction materials for the individual patient, especially for the children and young patient groups. All current approaches are imperfect and subject patients to one or more post-operative risks including thrombosis, calcification, adverse haemodynamic effects, limited durability and increased susceptibility to infection, as well as risks associated with prosthesis mismatch, variations in surgical technique and poor pre-operative planning, which currently can be realised only after fully developed post-operatively into the patient. These complications can vary significantly between individual patients, and can consequently lead to expensive, and usually dangerous, re-operations. Currently, there is a big drive towards more personalised therapies and surgical interventions, which aims at improving clinical outcomes by prolonging the survival of prostheses and alleviating costly and dangerous reoperations. Nowadays, it is widely accepted that the choice of intervention, as well as the clinical outcome and postoperative complications, are largely patient-dependent. Currently, however, the post-operative phase is, to a large extent, unpredictable. Current practices, especially in the case of new treatments and interventions, are largely based on "one size fits all" and "trial and error" philosophies, mainly due to the lack of any cost-effective, realistic and multi-parameter preclinical and pre-operative simulation models to personalise and tailor surgical treatment to a specific patient.
This doctoral project is aimed at developing a computational modelling platform for interrogating mitral valve replacement and consequent left ventricular remodelling. The project will develop a novel prognostic/forecasting tool that will enable cardiac surgeons to make patient-specific pre-operative decisions by optimising mitral valve replacement, in terms of a cohort of variables, including intervention type (repair; transcatheter or surgical replacement), valve prosthesis type and size, tissue sparing, and surgical technique. The optimisation will be based on patient-specific parameters whereas the prognosis will be based on forecasted post-operative haemodynamics and biomechanics of the left heart and simulate long-term implant performance and ventricular adaptation/remodelling. The project will develop a virtual platform, which can be tailored to a patient's specific left heart (including, mitral and aortic valves, ventricle and aortic arch) anatomy, physiology and haemodynamics, and simulate post-operative outcomes and performance of mitral valve repair and replacement. The project will enhance our understanding of mitral valve and ventricular function following surgical intervention, with a view to assisting surgeons in predicting possible post-operative outcomes and complications prior to the intervention. It will also enable the virtual preclinical testing of new valve prostheses and novel surgical interventions.