Mitral Annular Remodeling for MR Therapy

MR 治疗的二尖瓣环重塑

• 批准号: 6959620
• 负责人: Kiyotaka Fukamachi
• 金额: $ 38.52万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-01 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6959620
• 关键词: blood flow measurement; cardiovascular disorder therapy; disease /disorder model; dogs; echocardiography; fluorocarbon polymers; heart circulation; hemodynamics; human therapy evaluation; injection /infusion; mitral valve insufficiency; model design /development; organosilicon compound; tachycardia; technology /technique development

DESCRIPTION (provided by applicant): Functional mitral regurgitation (MR) plays a pivotal role in the pathophysiology of the congestive heart failure (CHF), a major cause of cardiac morbidity and mortality. Surgical therapy for functional MR has been limited in patients with severe CHF by relatively high operative mortality rates due to the effects of cardiopulmonary bypass and sternotomy. Therefore, there is a need for a minimally invasive method to treat MR to reduce patient risk. The purpose of this proposed program is to develop a new procedure for MR treatment: mitral annular remodeling resulting from a non-absorbable substance injection into the posterior mitral annulus. This procedure may enable the septal-lateral dimension to be efficiently reduced thus reducing MR without employing cardiopulmonary bypass or implanting a device into the coronary sinus. If this mitral annular remodeling proves to be efficacious in reducing functional MR, further development of a new device that will allow for percutaneously injection of the substance through the coronary sinus will be undertaken in the future. Therefore, as a first step in this process, we propose to evaluate the effects of mitral annular remodeling resulting from a nonabsorbable substance injection using an epicardial approach. To achieve this goal, the Specific Aims of this proposed program are: (1) to assess the feasibility of a precise injection of a nonabsorbable substance into the posterior mitral annulus on a beating heart in healthy canines, (2) to evaluate acute effects of mitral annular remodeling on the geometry of the mitral apparatus and the degree of MR in a canine tachycardia-induced MR model, and (3) to evaluate long-term effects of mitral annular remodeling on MR, tissue reaction, coronary circulation, and LV function by comparison with a tachycardia-induced MR Control group. Successful completion of this research program will provide us with preliminary data that will support our future program in which the development of a new percutaneously delivered device will allow for injection of the substance through the coronary sinus. Therefore, this proposed research program is an important first step in this novel procedure's development as one potential therapeutic option for high-risk CHF patients with functional MR.

描述（由申请人提供）：功能性二尖瓣反流（MR）在充血性心力衰竭（CHF）的病理生理学中发挥着关键作用，充血性心力衰竭是心脏发病和死亡的主要原因。由于体外循环和胸骨切开术的影响，功能性 MR 的手术治疗在严重 CHF 患者中受到限制，手术死亡率相对较高。因此，需要一种微创方法来治疗MR以降低患者风险。该计划的目的是开发一种新的 MR 治疗方法：通过将不可吸收物质注射到后二尖瓣环中来实现二尖瓣环重塑。该手术可以有效地减小间隔横向尺寸，从而减少 MR，而无需采用心肺旁路或将装置植入冠状窦。如果这种二尖瓣环重塑被证明可以有效减少功能性 MR，那么未来将进一步开发一种新设备，允许通过冠状窦经皮注射该物质。因此，作为该过程的第一步，我们建议评估使用心外膜方法注射不可吸收物质对二尖瓣环重塑的影响。为了实现这一目标，该计划的具体目标是：(1) 评估将不可吸收物质精确注射到健康犬的跳动心脏后二尖瓣环中的可行性，(2) 评估二尖瓣环重塑对犬心动过速诱发的 MR 模型中二尖瓣装置的几何形状和 MR 程度的影响，以及 (3) 评估二尖瓣环重塑对与心动过速诱导的 MR 对照组相比，MR、组织反应、冠脉循环和左心室功能。该研究计划的成功完成将为我们提供初步数据，以支持我们未来的计划，在该计划中，开发一种新的经皮输送装置将允许通过冠状窦注射该物质。因此，这项拟议的研究计划是这一新手术开发的重要第一步，作为具有功能性 MR 的高危 CHF 患者的潜在治疗选择。

项目成果

Mitral annular remodeling to treat functional mitral regurgitation: a pilot acute study in a canine model.

二尖瓣环重塑治疗功能性二尖瓣反流：犬模型的初步急性研究。

• 发表时间: 2010-08
• 作者: Fumoto, Hideyuki;Takaseya, Tohru;Shiose, Akira;Saraiva, Roberto M;Arakawa, Yoko;Park, Margaret;Rao, Santosh;Dessoffy, Raymond;Chen, Ji;Zhou, Qun;Calabro Jr, Anthony;Banbury, Michael;Fukamachi, Kiyotaka
• 通讯作者: Fukamachi, Kiyotaka

A novel technique for functional mitral regurgitation therapy: mitral annular remodeling.

功能性二尖瓣反流治疗的新技术：二尖瓣环重塑。

• 发表时间: 2006
• 作者: Kamohara, Keiji;Banbury, Michael;Calabro, Anthony;Popovic, Zoran B;Darr, Aniq;Ootaki, Yoshio;Akiyama, Masatoshi;Cingoz, Faruk;Ootaki, Chiyo;Kopcak, Michael W;Dessoffy, Raymond;Liu, Jenny;Fukamachi, Kiyotaka
• 通讯作者: Fukamachi, Kiyotaka