Quantitative Methods for Optimizing IMR Repair

优化 IMR 修复的定量方法

• 批准号: 10320967
• 负责人: Robert C Gorman
• 金额: $ 75.67万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-04 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10320967
• 关键词: Affect; Age; Agreement; American; Anatomy; Animal Model; Animals; Anterior; Calibration; Cells; Clinical; Clinical Research; Clinical Trials; Computer Models; Computer software; Consensus; Coronary Artery Bypass; Coupled; Data; Data Reporting; Development; Devices; Dilatation - action; Elements; Etiology; Evaluation; Geometry; Goals; Human; Image; Image Analysis; Image-Guided Surgery; Knowledge; Left Ventricular Function; Left Ventricular Remodeling; Measures; Mechanics; Methodology; Methods; Mitral Valve; Mitral Valve Insufficiency; Modeling; Myocardial Infarction; Pathogenesis; Pathology; Patients; Phase; Population; Postoperative Period; Procedures; Public Health; Recurrence; Registries; Resolution; Retrospective Studies; Secondary to; Sheep; Stress; Structure; Structure of chordae tendineae cordis; Techniques; Three-Dimensional Echocardiography; Time; Tissues; Validation; Work; base; clinical application; comparative efficacy; design; hemodynamics; imaging software; in silico; in vitro Model; in vivo; interest; novel; papillary muscle; patient subsets; prospective; randomized trial; repaired; sheep model; simulation; tool; translation to humans

Ischemic mitral regurgitation (IMR) occurs when a mitral valve (MV) is rendered incompetent by left ventricular (LV) remodeling induced by a myocardial infarction (MI). IMR is present in over 50% of patients with reduced LV function undergoing coronary artery bypass grafting (CABG) and affects at least 300,000 Americans. The magnitude of the problem is significant and is expected to grow substantially during the next 20 years as the population ages. MV repair with undersized ring annuloplasty is currently the preferred treatment for IMR. However, 1/3 of all patients treated this way develop significant recurrent IMR within 12 months. Using our real time 3D echocardiography (rt-3DE) image software we have demonstrated that IMR in humans is heterogeneous. In some patients the cause of IMR is annular dilatation and flattening. While in others leaflet tethering is the major pathology. In recent work we have demonstrated that it is in the latter group that undersized ring annuloplasty does not provide durable IMR repair. There is now agreement that adjunctive procedures are required to treat IMR caused by leaflet tethering. But there is no consensus regarding the best procedure. Despite significant interest in developing these procedures the reported data are from small, single center retrospective studies. Multi-center registries and randomized trials would be necessary to prove which procedure is superior. Given the number of proposed procedures and the complexity and duration of such studies it is highly unlikely that IMR procedure optimization could be effectively carried out this way. It is thus becoming clear that novel computational approaches directed towards optimized annuloplasty ring design and leaflet augmentation procedures can substantially reduce wasted time by minimizing trial-and-error approaches. We thus hypothesize that our state-of-the-art MV computational models, which can directly utilize rt-3DE imaging data coupled to novel effective MV leaflet and chordae tendonae (MVCT) structures, can be used in conjunction with clinically applicable large animal models to develop quantitatively optimize devices and procedures to treat IMR secondary to leaflet tethering. To prove this hypothesis the following specific aims will be achieved by leveraging our group's expertise in: 1) the pathogenesis of IMR, 2) IMR animal models, 3) rt-3DE MV imaging, 4) annuloplasty ring design, 4) MV cell-tissue coupled models, and 5) micro- and macro-anatomically accurate MV finite element models.

缺血性二尖瓣反流（IMR）发生时，二尖瓣（MV）的功能不全

项目成果

Invited Commentary.

特邀评论。

• DOI: 10.1016/j.jvs.2008.11.103
• 发表时间: 2009
• 期刊: Journal of vascular surgery
• 影响因子: 4.3
• 作者: Dardik,Alan

Computational Investigation of Transmural Differences in Left Ventricular Contractility.

左心室收缩力跨壁差异的计算研究。

• DOI: 10.1115/1.4034558
• 发表时间: 2016
• 期刊: Journal of biomechanical engineering
• 作者: Wang,Hua;Zhang,Xiaoyan;Dorsey,ShaunaM;McGarvey,JeremyR;Campbell,KennethS;Burdick,JasonA;Gorman3rd,JosephH;Pilla,JamesJ;Gorman,RobertC;Wenk,JonathanF
• 通讯作者: Wenk,JonathanF

In-vivo transducer to measure dynamic mitral annular forces.

用于测量动态二尖瓣环力的体内传感器。

• DOI: 10.1016/j.jbiomech.2012.03.009
• 发表时间: 2012
• 期刊: Journal of biomechanics
• 影响因子: 2.4
• 作者: Siefert,AndrewW;Jimenez,JorgeH;West,DustinS;Koomalsingh,KevinJ;Gorman,RobertC;Gorman3rd,JosephH;Yoganathan,AjitP
• 通讯作者: Yoganathan,AjitP

An ovine model of pulmonary insufficiency and right ventricular outflow tract dilatation.

肺功能不全和右心室流出道扩张的绵羊模型。

• 发表时间: 2012
• 期刊: The Journal of heart valve disease
• 作者: Robb,JDaniel;Harris,MatthewA;Minakawa,Masahito;Rodriguez,Evelio;Koomalsingh,KevinJ;Shuto,Takashi;Dori,Yoav;Gorman,RobertC;Gorman3rd,JosephH;Gillespie,MatthewJ
• 通讯作者: Gillespie,MatthewJ

Isogeometric finite element-based simulation of the aortic heart valve: Integration of neural network structural material model and structural tensor fiber architecture representations.

• DOI: 10.1002/cnm.3438
• 发表时间: 2021-04
• 期刊: International journal for numerical methods in biomedical engineering
• 影响因子: 2.1
• 作者: Zhang W;Rossini G;Kamensky D;Bui-Thanh T;Sacks MS
• 通讯作者: Sacks MS