Simulation of Coronary Artery Bypass Graft and Surgical Ventricular Restoration

描述(申请人提供)：心力衰竭在美国已经达到流行的程度，每年导致近50万人死亡。目前，大多数心力衰竭病例都是梗死性左心室重构的结果。由于缺乏完善的有效治疗方法，心力衰竭患者姑息治疗的内科和外科选择不断增加。冠状动脉旁路移植术(CABG)和外科心室重建术(SVR)是NIH正在进行的耗资3800万美元的多中心随机STICH试验(将于2008年完成)中的两个外科选择。最近完成的另一项随机试验首次表明，在冠状动脉疾病引起的心力衰竭患者中，CABG SVR比单独CABG更有益处。进一步证实，对于左心功能严重减退的患者，SVR手术是安全的。广泛的长期目标：开发和验证一个公共领域的软件工具，使临床医生能够轻松地模拟CABG和SVR对缺血性心力衰竭患者的影响。具体目标：1.仅使用公共领域软件开发基于物理的CABG和SVR模拟。2.对STICH患者进行术前、术后CT和MRI检查，以量化其室壁形态和功能，以及冠状动脉解剖和血流分布。3.使用在AIM#2中获取的LV功能和冠脉血流数据验证AIM#1中的模拟。此外，作为广泛传播给用户社区的存储库的一部分，CABG和SVR模型将通过斯坦福大学国家生物结构物理模拟中心(Simbios)的模拟工具包(SimTK)提供。这些模型和工具将补充正在进行的工作，这是Charley Taylor博士领导的Simbios驱动生物学问题之一的一部分，该问题侧重于主动脉中的血液流动和移植物，并将在SimTK中提供更大的流体流动建模能力。由此产生的计算模型提供了以其他方式无法获得的额外信息。具体地说，心脏外科医生将能够在手术前预测CABG和SVR对个别患者的影响。最重要的是，这种以生物工程为基础的方法进一步了解心力衰竭患者的心肌结构-功能关系，将为临床医生提供一种全新的方法来评估和治疗他们的患者，这最终将导致改善患者护理。

DESCRIPTION (provided by applicant): Heart failure has reached epidemic proportions in the United States and is responsible for nearly 500,000 deaths each year. The majority of heart failure cases is now the result of infarction- induced left ventricular (LV) remodeling. The lack of a well-established effective treatment has lead to a continually expanding list of medical and surgical options for the palliation of heart failure patients. Coronary artery bypass grafting (CABG) and surgical ventricular restoration (SVR) are the two surgical options included in the ongoing $38 million NIH-sponsored multi- center randomized STICH trial (to be completed in 2008). Another recently completed randomized trial has shown for the first time a benefit of CABG + SVR over CABG alone in patients with heart failure caused by coronary artery disease. Moreover, it confirms that the SVR procedure can be performed safely in patients with severely reduced LV function. Broad, Long-Term Objective: Develop and validate a public-domain software tool that will enable clinicians to easily simulate the effects of CABG and SVR on patients with ischemic heart failure. Specific Aims: 1. Develop physics-based simulations of CABG and SVR using only public-domain software. 2. Perform pre- and post-operative CT and MRI exams on STICH patients in order to quantify their LV wall geometry and function and coronary artery anatomy and blood flow distribution. 3. Validate the simulations in Aim #1 using the LV function and coronary blood flow data acquired in Aim #2. In addition, as part of a repository for wide dissemination to the user community, CABG and SVR models will be made available via the simulation tool kit (SimTK) of Stanford's National Center for Physics-Based Simulation of Biological Structures (Simbios). These models and tools will complement work that is ongoing as part of one of the Simbios driving biological problems lead by Dr. Charley Taylor that focuses on blood flow and grafts in the aorta, and will provide a larger repertoire of fluid flow modeling capabilities in SimTK. The resulting computational models provide additional information not otherwise available. Specifically, cardiac surgeons will be able to predict the effects of CABG and SVR on individual patients before surgery. Most important, this bioengineering-based approach to further current understanding of myocardial structure-function relations in heart failure will offer clinicians an entirely new approach to assessment and treatment of their patients, which should ultimately lead to improved patient care.