Surgical Planning Tool for Aortic Valve Reconstruction

主动脉瓣重建手术计划工具

• 批准号: 8856326
• 负责人: Pedro J. del Nido
• 金额: $ 52.18万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-06 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8856326
• 关键词: Address; Affect; Anatomy; Anticoagulation; Aorta; Autologous Transplantation; Balloon Dilatation; Bioprosthesis device; Bypass; Caliber; Cardiac; Child; Chronic; Clinical; Collaborations; Computer Simulation; Computing Methodologies; Congenital Heart Defects; Defect; Development; Diastole; Elements; Engineering; Esophageal; Evaluation; Family suidae; Functional disorder; Geometry; Goals; Heart; Heart Valves; Image; Image Analysis; Implant; Infant; Infection; Infective endocarditis; Learning; Left; Lesion; Life; Life Style; Lung; Measurement; Methodology; Methods; Mitral Valve; Modeling; Morbidity - disease rate; Neonatal; Only Child; Operating Rooms; Operative Surgical Procedures; Patients; Pericardial body location; Physiological; Plant Roots; Procedures; Property; Prosthesis; Pulmonary valve structure; Risk; Source; Stress; Surgeon; Techniques; Technology; Testing; Three-Dimensional Imaging; Tissues; Ultrasonography; Validation; Work; aortic valve; aortic valve disorder; aortic valve replacement; base; calcification; clinical care; experience; hemodynamics; image processing; imaging modality; implantation; improved; model building; mortality; operation; palliative; pericardial sac; pressure; reconstruction; repaired; simulation; tool; valve replacement; young adult

DESCRIPTION (provided by applicant): Aortic valve disease is the third most common congenital left heart lesion, affecting 8% of all children born with heart defects. Aortic valve replacement (AVR) in children, while feasible, carries a significant early and late morbidity and mortality such that by 10 years following AVR only 47% of children are alive and without valve re-replacement. Complications of anticoagulation, infection and valve dysfunction are some of the causes of morbidity and mortality in active children. For this reason alternative procedures such as aortic valve repair (AVre), remain a preferable approach to prosthetic replacement. AVre, however, is a technically demanding procedure. Analysis of mechanisms of valve dysfunction, precise measurement of leaflet and root geometry, and decisions regarding repair patch size, must be made intra-operatively while the heart is arrested and the aorta open. In experienced centers, however, the short and long-term results of AVre are excellent but the repair rate remains suboptimal due in great part to the trial and error method applied. The main goal of AVre is to repair the geometry of the valve leaflets using non-leaflet tissue (pericardium treated with gluteraldehyde) to generate valve closure during diastole. While experienced surgeons are able to do this intra-operatively, consistent results and widespread application of AVre has been limited due to the steep "learning curve" with the procedure. To address these impediments to the application of AVre more widely, we propose to utilize the recent advances in 3D ultrasound imaging combined with image processing and modeling techniques to develop a tool for pre-procedure analysis of aortic valve function, and for surgical planning. Ultimately, the goal is to have a tool that can be used in the operating room, utilizing intra-operative imaging for analysis and planning. We propose three Specific Aims: Aim 1. Develop methodology for defining valve geometry, including: segmentation, statistical geometric models, and computational meshes. Aim 2. Develop and validate patient-specific finite element- based simulation of aortic valve closure and of valve repair. Aim 3. Create an interface between clinicians and technical developments to enable the work-flow for aortic valve repair planning, including end-template. To accomplish these goals we will employ a partnership with expertise in 3D ultrasound image processing, model building, and clinical aortic valve repair. This partnership has unique access to clinical care, industrial engineering and modeling, and a long track record of collaboration.

描述（由申请人提供）：主动脉瓣疾病是第三大最常见的先天性左心病变，影响8%的先天性心脏缺陷儿童。儿童主动脉瓣置换术（AVR）虽然可行，但会带来显着的早期和晚期发病率和死亡率，因此到AVR后10年，只有47%的儿童存活且无需再次置换瓣膜。抗凝、感染和瓣膜功能障碍的并发症是活跃儿童发病率和死亡率的一些原因。出于这个原因，诸如主动脉瓣修复（AVre）的替代手术仍然是假体置换的优选方法。然而，AVre是一个技术要求很高的程序。术中必须在心脏停搏和主动脉开放时分析瓣膜功能障碍的机制，精确测量瓣叶和根部几何形状，并决定修补补片的尺寸。然而，在经验丰富的中心，AVre的短期和长期结果都很好，但修复率仍然不理想，这在很大程度上是由于采用了试错法。AVre的主要目标是使用非瓣叶组织（用戊二醛处理的心包）修复瓣叶的几何形状，以在瓣膜植入期间实现瓣膜闭合。虽然经验丰富的外科医生能够在术中做到这一点，但由于该手术的陡峭"学习曲线"，AVre的一致结果和广泛应用受到限制。为了更广泛地解决AVre应用的这些障碍，我们建议利用三维超声成像的最新进展，结合图像处理和建模技术，开发一种用于主动脉瓣功能术前分析和手术规划的工具。最终，我们的目标是拥有一种可在手术室使用的工具，利用术中成像进行分析和规划。我们提出三个具体目标：目标1。制定用于定义瓣膜几何形状的方法，包括：分割、统计几何模型和计算网格。目标二。开发并验证基于患者特定有限元的主动脉瓣关闭和瓣膜修复模拟。目标3。在临床医生和技术开发人员之间创建接口，以实现主动脉瓣修复计划的工作流程，包括端模板。为了实现这些目标，我们将与3D超声图像处理、模型构建和临床主动脉瓣修复方面的专业人员合作。这种合作关系在临床护理、工业工程和建模方面具有独特的优势，并且有着长期的合作记录。

项目成果

Surgical reconstruction of semilunar valves in the growing child: Should we mimic the venous valve? A simulation study.

在成长中的儿童中半路瓣的手术重建：我们应该模仿静脉瓣吗？模拟研究。

• DOI: 10.1016/j.jtcvs.2016.08.019
• 发表时间: 2017-02
• 期刊: The Journal of thoracic and cardiovascular surgery
• 作者: Hammer PE;Roberts EG;Emani SM;Del Nido PJ
• 通讯作者: Del Nido PJ

Intraoperative Echocardiography for Congenital Aortic Valve Repair: Predictors of Early Reoperation.

先天性主动脉瓣修复术中超声心动图：早期再手术的预测因素。

• DOI: 10.1016/j.athoracsur.2015.05.002
• 发表时间: 2015
• 期刊: The Annals of thoracic surgery
• 作者: Stern,KenanWD;White,MatthewT;Verghese,GeorgeR;DelNido,PedroJ;Geva,Tal
• 通讯作者: Geva,Tal

Surgical repair of congenital aortic regurgitation by aortic root reduction: A finite element study.

• DOI: 10.1016/j.jbiomech.2015.09.030
• 发表时间: 2015-11-05
• 期刊: Journal of biomechanics
• 影响因子: 2.4
• 作者: Hammer PE;Berra I;del Nido PJ
• 通讯作者: del Nido PJ

Three-Dimensional Mitral Valve Morphology in Children and Young Adults With Marfan Syndrome.

Marfan综合征儿童和年轻人的三维二尖瓣瓣膜形态。

• DOI: 10.1016/j.echo.2018.06.009
• 发表时间: 2018-11
• 期刊: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
• 作者: Jolley MA;Hammer PE;Ghelani SJ;Adar A;Sleeper LA;Lacro RV;Marx GR;Nathan M;Harrild DM
• 通讯作者: Harrild DM

Straightening of curved pattern of collagen fibers under load controls aortic valve shape.

负载下胶原纤维弯曲模式的拉直可控制主动脉瓣形状。

• DOI: 10.1016/j.jbiomech.2013.11.032
• 发表时间: 2014
• 期刊: Journal of biomechanics
• 影响因子: 2.4
• 作者: Hammer,PeterE;Pacak,ChristinaA;Howe,RobertD;delNido,PedroJ
• 通讯作者: delNido,PedroJ