Optimized Mitral Annuloplasty

优化二尖瓣环成形术

• 批准号: 9902537
• 负责人: Robert C Gorman
• 金额: $ 76.63万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9902537
• 关键词: 3-Dimensional; Animals; Autopsy; Award; Bite; Clinical; Data; Dilatation - action; Dimensions; Disease; Event; Exhibits; Failure; Frequencies; Future; Geometry; Heart; Histology; Hybrids; Implant; Lead; Measures; Mitral Valve Insufficiency; Modeling; Operative Surgical Procedures; Patients; Performance; Physiological; Positioning Attribute; Procedures; Property; Repeat Surgery; Shapes; Sheep; Statistical Models; Surgical sutures; Tissues; Transducers; base; design; effective therapy; effectiveness validation; experimental study; flexibility; implantation; instrument; novel; reconstruction; repaired; restoration; tool; treatment choice; valve replacement

Contact PD/PI: GORMAN, JOSEPH Ischemic Mitral Regurgitation (IMR) is a major clinical problem. Our group has demonstrated that IMR is a heterogeneous disease with two general subpopulations.(1) In one group, IMR results from moderate annular dilatation and profound leaflet tethering. We have shown these patients are best treated by valve replacement.(1, 2) In the second subpopulation, IMR is the result of severe annular dilatation (i.e. minimal leaflet tethering). Here, ring annuloplasty has been shown to be an effective treatment, provided the ring remains anchored to the annulus. The Achilles heel of these repairs is the higher suture forces required to downsize these large annuli, which predisposes to dehiscence. Ring dehiscence is estimated to underlie 13- 42% of reoperations for procedure-related repair failures.(3-5) Dehiscence occurs when the suture holding strength of the local tissue is exceeded by the force on the suture. We have developed novel transducers to measure ring suture force and quantified the effects of ring type, sizing, suture position, annular histology, and holding strength on dehiscence likelihood.(6-9) These studies have mechanistically demonstrated that ring flexibility significantly reduces suture forces, specifically in the weakest region of annular tissue. These results suggest that the incorporation of segmental ring flexibility to the already known functional benefits of saddle shape will produce IMR-specific rings that restore valve geometry while reducing dehiscence likelihood even in the setting of suboptimal suture placement. To this end, the following specific aims have been designed to prove the hypothesis: In the setting of IMR, new hybrid rigid-flexible annuloplasty rings are capable of both restoring normal valve geometry and reducing ring suture forces to a magnitude that overcomes the effect of suboptimal suture placement that otherwise would lead to an increased likelihood for dehiscence.

联系人 PD/PI：GORMAN、JOSEPH 缺血性二尖瓣反流（IMR）是一个主要的临床问题。我们的团队已经证明 IMR 是一种 具有两个一般亚群的异质性疾病。(1) 在一组中，IMR 源于中等环形 扩张和深刻的小叶束缚。我们已经证明这些患者最好的治疗方法是瓣膜置换术。（1， 2) 在第二个亚群中，IMR 是严重的环状扩张（即最小的小叶束缚）的结果。这里， 环成形术已被证明是一种有效的治疗方法，只要环保持锚定在 环。这些修复的致命弱点是缩小这些大环的尺寸所需的缝合力更高， 这容易导致开裂。据估计，环裂开是 13-42% 的再手术的原因 与手术相关的修复失败。(3-5) 当局部组织的缝线保持强度低于时，会发生裂开。 超过缝合线上的力。我们开发了新型传感器来测量环缝合力和 量化环类型、尺寸、缝合位置、环组织学和保持强度对开裂的影响 (6-9) 这些研究从机制上证明环的灵活性显着减少了缝合 力，特别是在环形组织的最薄弱区域。这些结果表明，并入 分段环的灵活性与已知的鞍形功能优势将产生 IMR 专用环 即使在缝合不理想的情况下，也能恢复瓣膜几何形状，同时减少裂开的可能性 放置。为此，设计了以下具体目标来证明该假设： IMR 的新型混合刚柔瓣环成形术环能够恢复正常的瓣膜几何形状 并将环形缝合力降低到克服次优缝合效果的程度 否则会导致开裂可能性增加。