Biomechanical Optimization of Cardiac Valve Repair Operations

项目摘要 心脏瓣膜病是全球发病率和死亡率的重要原因。不断发展的治疗指南 尽可能支持早期干预和瓣膜修复。修复技术的进步已经取得进展， 临床竞技场主要基于解剖学和生理学前提，偶尔基于视觉 和超声心动图表现。然而，生物力学工程的基础和原则， 很少研究瓣膜成形术。对这些原则有更深刻的理解， 结合到外科手术中可以增强瓣膜的可修复性和耐久性 为机械瓣膜长期抗凝治疗减少血栓栓塞和出血后遗症 置换术和因生物瓣膜退化而再次介入的围手术期风险较低。我们有 设计并制作了一种新型的3D打印左心模拟器，二尖瓣和主动脉瓣样本可以 在整个心动周期内进行安装和研究。多种免疫疾病状态可以重现，如 可以进行目前临床上使用的修复操作。创新的生物力学传感器和成像 这些技术有助于详细分析这些业务中的工程原理。比较 现代手术技术之间的显著功能差异的研究和识别已经 从使用该心脏瓣膜系统进行的研究中发现并发表。我们建议 深入研究离体主动脉瓣和二尖瓣修复手术，然后在大型动物模型中验证研究结果。 我们乐观地认为，拟议的实验将产生重要的知识，目前和潜在的未来 用于瓣膜疾病的临床治疗，并可快速转化为术中患者护理。

PROJECT SUMMARY Valvular heart disease is a significant cause of global morbidity and mortality. Evolving treatment guidelines support earlier intervention and valve repair when possible. Advances in repair techniques have progressed in the clinical arena primarily based upon anatomic and physiologic premises and occasionally based upon visual and echocardiographic appearance. Yet, the biomechanical engineering fundamentals and principles underlying valvuloplasty operations are rarely investigated. A more robust understanding of such principles and incorporation into surgical procedures may enhance valve reparability and durability and thus ultimately translate into less thromboembolic and hemorrhagic sequelae of long term anticoagulation for mechanical valve replacement and less perioperative risks of reintervention for bioprosthetic valve deterioration. We have designed and produced a novel 3D-printed left heart simulator into which mitral and aortic valve specimens can be mounted and studied throughout the cardiac cycle. Multiple regurgitant disease states can be reproduced, as can the current clinically-employed repair operations. Innovative biomechanical sensors and imaging technologies facilitate the detailed analysis of the engineering principles within these operations. Comparisons of and identification of notable functional differences among contemporary operative techniques have already been discovered and published from investigations performed using this heart valve system. We propose to study in depth aortic and mitral valve repair operations ex vivo and then validate findings in large animal models. We are optimistic that the proposed experiments will yield important knowledge on current and potential future clinical therapies for valve disease and can be rapidly translated to intraoperative patient care.