Optimized Mitral Annuloplasty

优化二尖瓣环成形术

• 批准号: 9902537
• 负责人: Robert C Gorman
• 金额: $ 76.63万
• 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: 2019-04-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9902537
• 关键词: 3-Dimensional; Animals; Autopsy; Award; Bite; Clinical; Data; Dilatation - action; Dimensions; Disease; Event; Exhibits; Failure; Frequencies; Future; Geometry; Heart; Histology; Hybrids; Implant; Lead; Measures; Mitral Valve Insufficiency; Modeling; Operative Surgical Procedures; Patients; Performance; Physiological; Positioning Attribute; Procedures; Property; Repeat Surgery; Shapes; Sheep; Statistical Models; Surgical sutures; Tissues; Transducers; base; design; effective therapy; effectiveness validation; experimental study; flexibility; implantation; instrument; novel; reconstruction; repaired; restoration; tool; treatment choice; valve replacement

Contact PD/PI: GORMAN, JOSEPH Ischemic Mitral Regurgitation (IMR) is a major clinical problem. Our group has demonstrated that IMR is a heterogeneous disease with two general subpopulations.(1) In one group, IMR results from moderate annular dilatation and profound leaflet tethering. We have shown these patients are best treated by valve replacement.(1, 2) In the second subpopulation, IMR is the result of severe annular dilatation (i.e. minimal leaflet tethering). Here, ring annuloplasty has been shown to be an effective treatment, provided the ring remains anchored to the annulus. The Achilles heel of these repairs is the higher suture forces required to downsize these large annuli, which predisposes to dehiscence. Ring dehiscence is estimated to underlie 13- 42% of reoperations for procedure-related repair failures.(3-5) Dehiscence occurs when the suture holding strength of the local tissue is exceeded by the force on the suture. We have developed novel transducers to measure ring suture force and quantified the effects of ring type, sizing, suture position, annular histology, and holding strength on dehiscence likelihood.(6-9) These studies have mechanistically demonstrated that ring flexibility significantly reduces suture forces, specifically in the weakest region of annular tissue. These results suggest that the incorporation of segmental ring flexibility to the already known functional benefits of saddle shape will produce IMR-specific rings that restore valve geometry while reducing dehiscence likelihood even in the setting of suboptimal suture placement. To this end, the following specific aims have been designed to prove the hypothesis: In the setting of IMR, new hybrid rigid-flexible annuloplasty rings are capable of both restoring normal valve geometry and reducing ring suture forces to a magnitude that overcomes the effect of suboptimal suture placement that otherwise would lead to an increased likelihood for dehiscence.

联系PD/PI：Gorman，Joseph 缺血性二尖瓣反流（IMR）是一个主要的临床问题。我们的小组证明了IMR是一个 异质性疾病具有两个一般亚群。（1）在一组中，IMR是由中等环形的 扩张和深刻的小叶束缚。我们已经显示这些患者最好通过更换瓣膜治疗。（1， 2）在第二个亚群中，IMR是严重的环形扩张的结果（即最小的小叶束缚）。这里， 环形环形成形术已被证明是一种有效的治疗方法，只要环仍然固定在 环。这些维修的致命脚跟是缩小这些大尺寸的较高缝合力， 易于开裂。据估计，弹性裂开为13-42％的重新运作 与程序相关的修复故障。（3-5）当局部组织的缝合线保持强度为 超过缝合线的力。我们已经开发了新颖的传感器来测量环缝合力和 量化环类型，尺寸，缝合位置，环形组织学和保持强度对裂开的影响 可能性。（6-9）这些研究从机械上证明了环灵活性可显着降低缝合线 力，特别是在环形组织的最弱区域。这些结果表明合并 对鞍形形状的已知功能优势的节段环灵活性将产生IMR特异性环 还原阀几何形状，同时减少开裂的可能性，即使在次优缝合线的情况下 放置。为此，已经设计了以下特定目标来证明这一假设：在环境中 在IMR中，新的混合刚性固定环形成形术环能够恢复正常阀几何形状 并将环缝合力减少到一个克服次优缝合线的影响的大小 否则将导致开裂的可能性增加。