Impact of mitral valve interventions on left ventricular hemodynamics: Insights into energy loss and flow dynamics.

Objectives: Left ventricular vortex dynamics play a crucial role in cardiac function but are significantly altered by mitral valve diseases or surgical interventions. Such hemodynamic changes may lead to maladaptive intracardiac vortices, potentially triggering pathways associated with progressive left ventricular remodeling and thrombosis. This study assessed left ventricular hemodynamics under both physiological and pathological conditions using a biohybrid in vitro platform, aiming to analyze the impact of these conditions on cardiac function. Methods: An in vitro platform was established to simulate 6 mitral valve conditions: healthy, mitral regurgitation, bioprosthetic valve replacement, mechanical valve replacement (in 2 orientations), and transcatheter mitral valve edge-to-edge repair. Flow fields within the left ventricle were captured using 4-dimensional particle image velocimetry, including mean flow fields, vortex depth, vortex transversal position, viscous shear stress, and energy dissipation. Results: Mitral regurgitation preserved vortex structure compared with healthy conditions. Mechanical valves altered vortex direction and reduced vortex transversal position (0.66-0.47, Conclusions: Preserving native valve function optimizes left ventricular hemodynamics, whereas valve replacements and transcatheter mitral valve edge-to-edge repair alter flow patterns, increasing cardiac workload and thrombotic risks. These findings underscore the importance of assessing left ventricular flow dynamics in the treatment of mitral regurgitation.