Image-guided Intracardiac Beating Heart Surgery

描述（由申请人提供）：图像引导手术干预治疗心脏缺陷提供了最大限度地减少手术的侵入性，避免心内直视手术和体外循环，并缩短恢复时间的承诺。除了这些进步之外，它们还有望在修复过程中提供心脏结构和功能的实时生理信息，从而潜在地改善重建手术的结果。然而，为了实现这些目标，需要在成像技术、程序开发和仪器设计方面取得一些进步。在我们目前的BRP中，我们专注于开发成像，图像处理和显示技术，以及在相对静态结构（如房间隔缺陷）中进行跳动心脏修复的设备。我们已经成功地对各种房间隔缺损进行了心脏搏动修复，并开发了技术（成像、导航辅助和设备），目前正在开发一期临床试验。在本提案中，我们计划进一步开发技术和设备来修复涉及高流动性和难以成像的结构缺陷。我们将使用三种常见的手术：心房颤动的组织消融、室间隔缺损的闭合和二尖瓣小叶脱垂的修复作为我们发展这项技术的平台手术。这些程序代表了修复先天性和获得性心脏缺陷的常见手术，与本提案相关，它们代表了当前跳动心脏干预的重大技术挑战。在目标1中，我们将：开发高空间和时间分辨率的超声成像；在目标2，我们将：开发高空间和时间分辨率成像为基础的跟踪方法和显示组织和仪器；在目标3中，我们将：设计设备，以及灵巧，高速，驱动的递送仪器，用于抓取和附着在高度移动和微妙的心脏内结构上。我们将保持多学科的研究团队，他们在目前的BRP拨款中密切合作，现在解决更具挑战性的问题，即在跳动的心脏中快速移动的结构，以及需要复杂导航和高分辨率成像的缺陷。这些工具和技术的发展将使导管和搏动心脏手术为基础的重建手术修复广泛的心脏内缺陷。

DESCRIPTION (provided by applicant): Image guided surgical interventions to treat cardiac defects offer the promise of minimizing the invasiveness of the procedure, avoiding open heart surgery and cardiopulmonary bypass, and reducing recovery time. Beyond these advances, they also offer the promise of providing real-time physiologic information on structure and function of the heart during the repair, potentially improving outcome in reconstructive operations. To realize these objectives however, a number of advances are required in imaging technology, procedure development, and instrument design. In our current BRP we have focused on developing imaging, image processing and display techniques, and devices to perform beating heart repair in relatively static structures such as atrial septal defects. We have succeeded in performing beating heart repair in a wide variety of atrial septal defects and have developed the technology (imaging, navigation aids, and devices) to a level where phase I clinical trials are now being developed. In this proposal we plan to further develop technology and devices to repair defects that involve highly mobile and difficult to image structures. We will use three common procedures: Tissue ablation for atrial fibrillation, closure of ventricular septal defect, and repair of prolapsed mitral leaflet as our platform procedures to develop the technology. These procedures represent common operations performed to repair congenital and acquired heart defects and, relevant to this proposal, they represent a current and significant technical challenge for beating heart intervention. In Aim 1 we will : Develop high spatial and temporal resolution ultrasound imaging; in Aim 2 we will: Develop high spatial and temporal resolution imaging-based tracking methods and displays for tissue and instruments; and in Aim 3 we will: Design devices, and dexterous, high-speed, actuated delivery instruments for grasping and attaching to highly mobile and delicate intracardiac structures. We will maintain the multidisciplinary team of investigators that has collaborated closely in the current BRP grant to now address the more challenging problem of working in the beating heart with structures that are moving rapidly, and defects that require complex navigation and high resolution imaging. Development of these tools and technology will enable catheter and beating heart surgery-based reconstructive operations to repair a wide range of intracardiac defects. PUBLIC HEALTH RELEVANCE Image guided beating heart repair of heart defects offers the promise of avoiding complex and risky open heart operations. We have developed techniques for performing repair of simple defects using 3-Dimensional ultrasound for imaging, image processing to provide instrument navigational aids inside the heart, and specialized surgical tools. We now propose to extend our work to address repair of complex heart lesions that require higher image resolution and specialized instruments to compensate for cardiac motion.