Towards Modeling the Hemodynamic Impact of Mitral and Aortic Valve Repair in Patients with Left Ventricular Assist Devices

Abstract

Valve dysfunction is a major threat to long-term success in left ventricle assist device (LVAD) therapy, with direct implications for right heart performance. In this study, we apply a patient-specific, image-based computational modeling framework to evaluate the hemodynamic impact of simulated mitral and aortic valve repair in five LVAD-supported patients. Each patient was modeled under four conditions: (patient-specific LVAD-supported state), simulated mitral valve (MV) repair, simulated aortic valve (AV) repair, and simulated combined MV&AV repair. Because validation data for valve repair were unavailable, the simulated repair scenarios are exploratory in silico interventions based on clinically validated patient-specific models. The models integrate dynamic CT imaging, echocardiography, catheterization data, and device-specific LVAD parameters into a coupled 3D-0D simulation pipeline. Valve dynamics are governed by transvalvular pressure and flow, allowing physiological modeling of regurgitant lesions and surgical repair. The right ventricular (RV) was assessed using a combination of model-derived metrics, including right ventricular ejection fraction (RVEF), pulmonary artery pulsatility index (PAPi), and RV-PA coupling. In addition, we performed blood residence time (RT) analysis to evaluate blood stasis within the left heart and aorta. The simulations suggest that valve repair improved cardiac output, reduced pulmonary congestion, and enhanced right ventricular loading conditions. Notably, mitral valve repair restored aortic valve opening during the cardiac cycle, which improved sinus washout and reduced blood residence time within the aortic root-factors associated with lower thrombotic risk. Overall, these findings suggest a potential role for valve repair in LVAD-supported hearts, though larger, validated patient cohorts are needed to confirm these results.