Hemodynamics of thrombosis after transcatheter aortic valve-in-valve implantation

摘要一 这是一份为岳璇博士申请的“指导定量研究发展奖”， 他是加州大学旧金山分校弗朗西斯科的生物医学研究科学家。宣医生正在树立自己的 主动脉瓣置换术患者导向研究的年轻研究者。K25奖将为宣博士提供 在必要的支持下实现以下目标：（1）专注于临床研究， 经导管瓣中瓣植入术后血栓形成;（2）获得放射学培训并识别风险 通过结合临床数据和患者特异性计算建模来确定血栓形成的因素;以及（3） 结合她的生物力学专业知识来回答心血管疾病治疗中的临床问题。 虽然宣博士在计算建模方面有着坚实的背景，但她在其他重要领域的背景却要差得多。 上面提到的学科。为了实现这些目标，宣博士组建了一支由以下人员组成的指导团队 主要导师，Elaine Tseng博士，加州大学旧金山分校外科教授，旧金山心胸外科主任 弗朗西斯科退伍军人事务医疗中心，共同导师，梁戈博士，助理兼职教授在加州大学旧金山分校， 他在升主动脉瘤和主动脉瓣疾病的计算建模方面具有专业知识， 导师Danny Dvir博士，瓣中瓣治疗和瓣膜退化的国际领导者， 华盛顿大学介入心脏病专家。宣博士还将与肯德里克·申克博士密切合作 加州大学旧金山分校和旧金山退伍军人事务部弗朗西斯科医疗中心的介入心脏病专家Jeffery Zimmet 瓣中瓣手术的临床问题指导团队还包括迈克尔·霍普博士， 加州大学旧金山分校副教授、旧金山退伍军人事务部弗朗西斯科医学中心放射科主任和大卫塞隆纳博士， 加州大学旧金山分校放射学教授和心血管MRI的国际领导者，他将监督和指导 医学成像和MRI研究。宣博士制定了结构化的培训计划， 培训，正式的课程，除了临床研究，医学成像和病人的多学科指导， 具体的计算模型。 经导管主动脉瓣中瓣（VIV）植入术是主动脉瓣治疗的一场革命 手术生物瓣膜失败后的疾病。拟议的研究将包括临床成像， 临床随访数据和患者特定的计算模拟，以解决最紧迫的问题， VIV后血栓形成。我们希望这些研究的结果将填补血栓形成的关键知识空白 从血流动力学角度，改善血栓形成的临床管理， 通过患者特异性风险预测改善未来的临床结果。这项研究将为 拟在R 01中提出的VIV手术中血栓形成和人工生物瓣膜失效的深入研究 在建议项目结束前申请资助。

ABSTRACT I This is an application for a Mentored Quantitative Research Development Award for Dr. Yue Xuan, a biomedical research scientist at the University of California, San Francisco. Dr. Xuan is establishing herself as a young investigator in patient-oriented research of aortic valve replacement. This K25 award will provide Dr. Xuan with the support necessary to accomplish the following goals: (1) to focus on clinical investigation of the thrombosis after transcatheter valve-in-valve implantation; (2) to acquire training in radiology and identify the risk factors of thrombosis by incorporating the clinical data and patient-specific computational modeling; and to (3) integrate her biomechanical expertise to answer clinical questions in the treatment of cardiovascular diseases. While Dr. Xuan has a solid background in computational modeling, she is much less so in the other important disciplines named above. To achieve these goals, Dr. Xuan has assembled a mentoring team comprised of a primary mentor, Dr. Elaine Tseng, Professor of Surgery at UCSF and Chief of Cardiothoracic Surgery in San Francisco Veterans Affairs Medical Center, co-mentor, Dr. Liang Ge, an Assistant Adjunct professor in UCSF, who has expertise in computational modeling of ascending aortic aneurysm and aortic valve disease, and co- mentor Dr. Danny Dvir, international leader in valve-in-valve therapies and valve degeneration and an interventional cardiologist in University of Washington. Dr. Xuan will also work closely with Dr. Kendrick Shunk and Jeffery Zimmet, interventional cardiologist in UCSF and San Francisco VA Medical Center, to understand the clinical questions of the valve-in-valve procedure. The mentoring team also includes Dr. Michael Hope, associate professor in UCSF and Chief of radiology in San Francisco VA Medical Center and Dr. David Saloner, professor in Radiology at UCSF and international leader in cardiovascular MRI, who will supervise and direct the medical imaging and MRI study. Dr. Xuan has developed structured training plan incorporating of didactic training, formal coursework, besides multidisciplinary mentorship in clinical study, medical imaging and patient- specific computational modeling. Transcatheter aortic valve-in-valve (VIV) implantation stands to revolutionize the treatment of aortic valve disease after a failed surgical bioprosthetic valve. The proposed study will incorporate both the clinical imaging, clinical follow-up data and patient-specific computational simulation to address the most urgent questions for the thrombosis after VIV. We expect the outcomes of these studies will fill critical knowledge gaps in thrombosis formation from the hemodynamics perspective, improve clinical management of thrombosis, and significantly improve the future clinical outcome through patient-specific risk prediction. This research will form the basis for an in-depth study of thrombosis and bioprosthetic valve failure in the VIV procedure, to be proposed in an R01 grant application before the end of the proposed project.