Surgical Planning Tool for Aortic Valve Reconstruction

主动脉瓣重建手术计划工具

• 批准号: 8706947
• 负责人: Pedro J. del Nido
• 金额: $ 51.91万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-06 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8706947
• 关键词: Address; Affect; Anatomy; Anticoagulation; Aorta; Autologous Transplantation; Balloon Dilatation; Bioprosthesis device; Bypass; Caliber; Cardiac; Child; Chronic; Clinical; Collaborations; Computer Simulation; Computing Methodologies; Congenital Heart Defects; Defect; Development; Diastole; Elements; Engineering; Esophageal; Evaluation; Family suidae; Functional disorder; Geometry; Goals; Heart; Heart Valves; Image; Image Analysis; Implant; Infant; Infection; Infective endocarditis; Learning; Left; Lesion; Life; Life Style; Lung; Measurement; Methodology; Methods; Mitral Valve; Modeling; Morbidity - disease rate; Neonatal; Only Child; Operating Rooms; Operative Surgical Procedures; Patients; Pericardial body location; Physiological; Plant Roots; Procedures; Property; Prosthesis; Pulmonary valve structure; Risk; Source; Stress; Surgeon; Techniques; Technology; Testing; Three-Dimensional Imaging; Tissues; Ultrasonography; Validation; Work; aortic valve; aortic valve disorder; aortic valve replacement; base; calcification; clinical care; experience; hemodynamics; image processing; imaging modality; implantation; improved; mortality; operation; palliative; pericardial sac; pressure; reconstruction; repaired; simulation; tool; valve replacement; young adult

DESCRIPTION (provided by applicant): Aortic valve disease is the third most common congenital left heart lesion, affecting 8% of all children born with heart defects. Aortic valve replacement (AVR) in children, while feasible, carries a significant early and late morbidity and mortality such that by 10 years following AVR only 47% of children are alive and without valve re-replacement. Complications of anticoagulation, infection and valve dysfunction are some of the causes of morbidity and mortality in active children. For this reason alternative procedures such as aortic valve repair (AVre), remain a preferable approach to prosthetic replacement. AVre, however, is a technically demanding procedure. Analysis of mechanisms of valve dysfunction, precise measurement of leaflet and root geometry, and decisions regarding repair patch size, must be made intra-operatively while the heart is arrested and the aorta open. In experienced centers, however, the short and long-term results of AVre are excellent but the repair rate remains suboptimal due in great part to the trial and error method applied. The main goal of AVre is to repair the geometry of the valve leaflets using non-leaflet tissue (pericardium treated with gluteraldehyde) to generate valve closure during diastole. While experienced surgeons are able to do this intra-operatively, consistent results and widespread application of AVre has been limited due to the steep "learning curve" with the procedure. To address these impediments to the application of AVre more widely, we propose to utilize the recent advances in 3D ultrasound imaging combined with image processing and modeling techniques to develop a tool for pre-procedure analysis of aortic valve function, and for surgical planning. Ultimately, the goal is to have a tool that can be used in the operating room, utilizing intra-operative imaging for analysis and planning. We propose three Specific Aims: Aim 1. Develop methodology for defining valve geometry, including: segmentation, statistical geometric models, and computational meshes. Aim 2. Develop and validate patient-specific finite element- based simulation of aortic valve closure and of valve repair. Aim 3. Create an interface between clinicians and technical developments to enable the work-flow for aortic valve repair planning, including end-template. To accomplish these goals we will employ a partnership with expertise in 3D ultrasound image processing, model building, and clinical aortic valve repair. This partnership has unique access to clinical care, industrial engineering and modeling, and a long track record of collaboration.

描述（由申请人提供）：主动脉瓣疾病是第三大常见的先天性左心病变，影响所有患有心脏缺陷的儿童中的8％。儿童的主动脉瓣置换术（AVR）虽然可行，但具有明显的早期和晚期发病率和死亡率，因此，在AVR后10年中，只有47％的儿童还活着，没有瓣膜重新替代。抗凝，感染和瓣膜功能障碍的并发症是活跃儿童发病率和死亡率的一些原因。因此，诸如主动脉瓣修复（AVRE）之类的替代程序仍然是假肢替代的一种优选方法。但是，Avre是一个技术要求的程序。分析瓣膜功能障碍的机制，小叶和根源的精确测量以及有关修复贴片大小的决策，必须在捕捉心脏时进行术中进行，并开放主动脉。但是，在经验丰富的中心中，AVRE的短期和长期结果非常出色，但维修率在很大程度上取决于使用的试验和错误方法。 AVRE的主要目的是使用非叶片组织（用戊二醛处理）修复瓣膜小叶的几何形状，以在舒张期间产生瓣膜闭合。尽管经验丰富的外科医生能够在术中进行此操作，但是由于该程序的陡峭“学习曲线”，因此量一致的结果和广泛的应用程序受到限制。为了更广泛地解决AVRE应用的这些障碍，我们建议利用3D超声成像中的最新进展，并结合图像处理和建模技术来开发一种工具，用于对主动脉瓣功能的预处理分析，以及手术计划。最终，目标是使用一个可以在手术室中使用的工具，利用术中成像进行分析和计划。我们提出了三个具体目标：目标1。开发定义阀几何形状的方法，包括：分割，统计几何模型和计算网格。 AIM 2。开发和验证患者特异性有限元的基于主动脉瓣闭合和瓣膜修复的模拟。 AIM 3。在临床医生和技术发展之间建立一个接口，以使包括末端模板在内的主动脉阀维修计划的工作流程。为了实现这些目标，我们将在3D超声图像处理，模型构建和临床主动脉瓣修复方面采用合作伙伴关系。该合作伙伴关系独特地获得了临床护理，工业工程和建模以及合作的悠久记录。