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

摘要I 这是为岳轩博士申请导师量化研究发展奖的申请书 加州大学旧金山分校的生物医学研究科学家。轩博士正在确立自己作为一名 以病人为中心的主动脉瓣置换术的年轻研究员。这个K25奖项将为宣威博士提供 在必要的支持下完成以下目标：(1)专注于临床研究 经导管瓣膜置入术后血栓形成；(2)接受放射学培训并识别风险 通过结合临床数据和患者特定的计算模型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，回答心血管疾病治疗中的临床问题。 虽然轩博士在计算建模方面有扎实的背景，但在其他重要的方面，她的背景要差得多 以上命名的学科。为了实现这些目标，轩博士组建了一个指导团队，成员包括 主要导师，旧金山加州大学旧金山分校外科教授兼心胸外科主任伊莱恩·曾医生 旧金山退伍军人事务医学中心，共同导师，加州大学旧金山分校助理兼职教授梁戈博士， 世卫组织在升主动脉瘤和主动脉瓣疾病的计算建模方面拥有专业知识，并与 导师丹尼·德维尔博士，瓣膜中瓣膜治疗和瓣膜退行性变的国际领先者 华盛顿大学的介入心脏病学家。Xuan博士还将与Kendrick Shunk博士密切合作 加州大学旧金山分校和旧金山退伍军人医学中心的介入心脏病专家杰弗里·齐梅特理解 瓣膜置换术的临床问题。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、旧金山退伍军人医学中心放射科主任大卫·塞隆纳博士， 加州大学旧金山分校放射学教授和心血管核磁共振领域的国际领导者，他将监督和指导 医学影像和核磁共振研究。轩博士制定了系统的培训计划，纳入了说教 培训，正规课程，除了临床研究、医学成像和患者方面的多学科指导- 具体的计算模型。 经导管主动脉瓣置入术将是主动脉瓣治疗的革命性进展 外科生物瓣膜手术失败后的疾病。这项拟议的研究将包括临床成像、 临床随访数据和特定患者的计算模拟，以解决最紧迫的问题 VIV后血栓形成。我们期望这些研究的结果将填补血栓形成方面的关键知识空白。 从血流动力学的角度形成，改善了血栓形成的临床管理，并显著 通过患者特定的风险预测来改善未来的临床结果。这项研究将为以下工作奠定基础 对VIV手术中血栓形成和生物瓣膜衰竭的深入研究，将在R01中提出 在拟议项目结束前批准申请。

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.