Image-guided Intracardiac Beating Heart Surgery

描述(申请人提供)：影像引导外科介入治疗心脏缺陷提供了将手术侵袭性降至最低、避免心内直视手术和体外循环以及缩短恢复时间的前景。除了这些进展，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，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展。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，以及在相对静止的结构(如房间隔缺损)中执行心脏跳动修复的设备。我们已经成功地对各种房间隔缺损进行了心脏不停跳修复，并将这项技术(成像、导航辅助设备和设备)开发到了正在进行I期临床试验的水平。在这项提案中，我们计划进一步开发技术和设备来修复涉及高度移动性和难以成像的结构的缺陷。我们将使用三种常见的手术程序：房颤的组织消融，室间隔缺损的缝合术，以及脱垂的二尖瓣叶修补术作为我们开发这项技术的平台程序。这些手术代表了修复先天性和获得性心脏缺陷的常见手术，与这一提议相关，它们代表了心脏不停跳干预目前的重大技术挑战。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中，我们将：为组织和器械开发基于高空间和时间分辨率成像的跟踪方法和显示器；在目标3中，我们将：设计设备，以及灵活、高速、致动的输送工具，用于抓住和附着高度移动和精细的心内结构。我们将维持在当前BRP拨款中密切合作的多学科调查团队，以解决更具挑战性的问题，即在心脏跳动中工作，结构快速移动，以及需要复杂导航和高分辨率成像的缺陷。这些工具和技术的开发将使基于导管和心脏不停跳手术的重建手术能够修复广泛的心脏内缺陷。 公共卫生相关图像引导心脏跳动中心脏缺陷修复提供了避免复杂和有风险的心内直视手术的前景。我们已经开发了使用三维超声进行成像修复简单缺陷的技术，使用图像处理提供心脏内的仪器导航辅助，以及专门的手术工具。我们现在建议扩大我们的工作，以解决复杂的心脏损伤的修复，这些损伤需要更高的图像分辨率和专门的仪器来补偿心脏运动。

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.