Image-guided Intracardiac Beating Heart Surgery

描述(由申请人提供)： 现代心脏外科实践包括常规使用体外循环(CPB)在心脏表面进行冠状动脉旁路移植(CABG)手术以及心脏内手术，广义上被归类为心内手术。然而，最近的研究表明，体外循环具有重要的风险，可能导致成人神经精神功能下降和中风，以及儿童神经发育缺陷和精细运动技能受损。CPB的其他不良反应包括激活炎症介质和补体级联，伴随着主动脉操纵和交叉阻断释放的颗粒性栓子阵雨，以及空气栓子。为了避免CPB的这些风险，一些研究人员已经开始评估在没有CPB的情况下进行CABG手术的结果。这些“心脏跳动”手术的早期结果表明，同等的通畅率、相似的死亡率和显著的节省。然而，心内不停跳心脏手术技术的发展必须克服独特的挑战，即无法以足够的细节和时间分辨率成像心脏的解剖特征，以允许仪器导航和精确的组织操作。实时3D ECHO有可能克服这些问题，从而使心内不停跳心脏手术成为可能。这项建议的总体目标是使实时三维超声成像特别适用于图像引导的干预，并通过仪器跟踪、触觉传感和声学组织分析将这项技术与安全措施相结合，以实现安全和准确的心内不停跳心脏手术。这个问题的复杂性非常适合于BRP方法。PI组建了一个多学科团队，并在行业工程师(飞利浦医疗系统公司)、大学工程师(哈佛大学、波士顿大学)和临床研究人员(儿童医院、布里格姆和妇女医院)之间建立了独特的合作伙伴关系。我们将共同解决这个问题，解决以下具体目标：目标一：修改实时三维超声，以优化图像呈现，以指导心脏跳动中的心内外科手术。目的II：采用高分辨率电磁跟踪设备进行精确的心内导航，并改进手术器械以减少心脏不停跳手术中对超声成像的干扰。目的III：开发同时提供触觉感觉和声学组织分析的仪器，以提高手术安全性。目的IV：将实时三维超声成像和跟踪设备与计算机增强的仪器控制相结合，以提高图像引导手术的任务性能和安全性。

DESCRIPTION (provided by applicant): Modem cardiac surgical practice involves the routine use of cardiopulmonary bypass (CPB) for performing both coronary artery bypass graft (CABG) procedures on the heart surface as well as procedures inside the heart, classified broadly as intracardiac surgery. However, recent studies indicate that CPB carries important risks that can lead to reduced neuropsychiatric function and stroke in adults, and neurodevelopmental deficits with impaired fine motor skills in children. Other adverse effects of CPB include activation of inflammatory mediators and the complement cascade, showers of particulate emboli with aortic manipulation and crossclamp release, and air embolus. To avoid these risks of CPB, several investigators have begun to evaluate the results of CABG procedures performed without CPB. Early results of these "beating heart" procedures indicate equivalent patency rates, comparable mortality rates, and significant savings. Development of techniques for intracardiac beating heart surgery, however, must overcome the unique challenge of the inability to image the anatomic features of the heart with sufficient detail and time resolution to permit instrument navigation and precise tissue manipulation. Real time 3D echo has the potential for overcoming these issues thereby enabling intracardiac beating heart surgery. The overall aim of this proposal is to adapt real time 3-D ultrasound imaging specifically for image-guided interventions and integrate this technology with safety measures through instrument tracking, tactile sensing, and acoustic tissue analysis to permit safe and accurate intracardiac beating heart surgery. The complexity of this problem is well suited to a BRP approach. The PI has assembled a multidisciplinary team and established a unique partnership among industry-based engineers (Philips Medical Systems), university-based engineers (Harvard University; Boston University), and clinical investigators (Children's Hospital; Brigham and Women's Hospital). Together, we will approach this problem by addressing the following specific aims: AIM I: Modify real-time 3-D ultrasound to optimize image presentation for guiding intracardiac surgical procedures in a beating heart. AIM II: Adapt high-resolution electromagnetic tracking equipment for precise intracardiac navigation and modify surgical instruments to limit interference with ultrasound imaging during beating heart surgical procedures. AIM III: Develop instruments to provide both tactile sensing and acoustic tissue analysis for increased procedure safety. AIM IV: Integrate real time 3-D ultrasound imaging and tracking equipment with computer-enhanced instrument control for improved task performance and safety during image-guided surgery.