Quantitative Force Measurements to Optimize Valve Repair for Ischemic MR

定量力测量优化缺血性 MR 瓣膜修复

• 批准号: 8824961
• 负责人: JOSEPH H GORMAN
• 金额: $ 71.5万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8824961
• 关键词: Affect; American; Anterior; Back; Caliber; Clinical; Consensus; Coronary Artery Bypass; Data; Dilatation - action; Engineering; Failure; Geometry; Health; Heart; Human; Image; In Vitro; Laws; Left; Left Ventricular Ejection Fraction; Left Ventricular Function; Left Ventricular Remodeling; Measurement; Measures; Mitral Valve; Mitral Valve Insufficiency; Modeling; Myocardial Infarction; Operative Surgical Procedures; Patients; Positioning Attribute; Procedures; Process; Recurrence; Reporting; Shapes; Stress; Techniques; Technology; Testing; Therapeutic; Three-Dimensional Echocardiography; Time; Tissues; Transducers; Ventricular; Work; design; follow-up; improved; in vitro Model; in vivo; innovation; instrument; novel; pre-clinical; quantitative imaging; repaired; success

DESCRIPTION (provided by applicant): Ischemic mitral regurgitation (IMR) occurs when a structurally normal mitral valve (MV) is rendered incompetent as a result of myocardial infarction induced left ventricular remodeling. IMR effects between 1.6 to 2.8 million Americans. Mitral valve repair with undersized flat ring annuloplasty has become the preferred treatment. However, recent studies have demonstrated this approach is associated with a failure rate of 30% within 6 months of surgery. Most failures result from progressive leaflet tethering and annuloplasty ring dehiscence which implicates annular and chordal stress distribution as a mechanism. These suboptimal stress profiles are due, in part, to the fact that undersized annuloplasty likely accentuates the LV remodeling process by further impairing basal LV geometry and function. The inadequacy of undersized annuloplasty results from its failure to fulfill two of Carpentier's fundamental requirements for successful mitral valve repair: it does no reestablish normal annular geometry nor does it adequately restore leaflet mobility. Preliminary work has demonstrated the promise of saddle-shaped annuloplasty and leaflet augmentation in improving IMR repair. However, there are currently no data to support a consensus as to the optimal repair technique for IMR. Therefore, we have designed the specific aims of this project to test the hypothesis that IMR repair techniques that normalize annular geometry and restore leaflet mobility will result in more durable repairs by promoting better basal LV function, less exacerbation of LV remodeling and reduced annular and chordal stress distribution. Our innovative approach to this critical clinical problem leverages our group's unique combination of surgical and engineering expertise. Using both in vivo and in vitro models of IMR in combination with novel imaging and force transducer technology, we will assess the effect annuloplasty shape and leaflet tissue augmentation on valvular force distribution. Such an experimental approach allows for the preclinical optimization of a mitral valve repair procedures for IMR so only the most promising techniques need to be tested in patients.

描述（由申请人提供）：当结构正常的二尖瓣（MV）由于心肌梗塞引起的左心室重构而变得功能不全时，就会发生缺血性二尖瓣反流（IMR）。 IMR 影响了 1.6 至 280 万美国人。采用小尺寸平环瓣环成形术进行二尖瓣修复已成为首选治​​疗方法。然而，最近的研究表明，这种方法在手术后 6 个月内的失败率高达 30%。大多数失败是由于渐进式小叶栓系和瓣环成形术环裂开造成的，这表明瓣环和弦应力分布是一种机制。这些次优应力分布的部分原因是，尺寸过小的瓣环成形术可能通过进一步损害左心室基础几何形状和功能而加剧左心室重塑过程。尺寸过小的瓣环成形术的不足之处在于它未能满足卡彭蒂埃成功修复二尖瓣的两个基本要求：它不能重建正常的瓣环几何形状，也不能充分恢复瓣叶的活动性。初步工作已经证明了鞍形瓣环成形术和小叶增强术在改善 IMR 修复方面的前景。然而，目前还没有数据支持对 IMR 最佳修复技术达成共识。因此，我们设计了该项目的具体目标，以检验这样的假设：使瓣环几何形状正常化并恢复小叶活动性的 IMR 修复技术将通过促进更好的左心室基础功能、减少左心室重塑的加剧以及减少瓣环和弦应力分布，从而实现更持久的修复。我们针对这一关键临床问题的创新方法利用了我们团队独特的外科和工程专业知识组合。使用 IMR 的体内和体外模型，结合新型成像和力传感器技术，我们将评估瓣环成形术形状和小叶组织增强对瓣膜力分布的影响。这种实验方法可以对 IMR 的二尖瓣修复手术进行临床前优化，因此只需在患者中测试最有前途的技术。