Biomechanical Optimization of Mitral Valve Repair Operations and Annuloplasty Rings for Primary Mitral Valve Regurgitation

原发性二尖瓣反流二尖瓣修复手术和瓣环成形术环的生物力学优化

基本信息

批准号：
10597517
负责人：
Yuanjia Zhu
金额：
$ 7.39万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10597517
关键词：
3D Print Adopted Advocate Anatomy Animal Model Animals Appearance Arrhythmia Biomechanics Cardiac Surgery procedures Chronic Clinical Complex Custom Data Development Echocardiography Engineering Excision Failure Fatigue Geometry Goals Guidelines Heart Heart Valve Diseases Heart failure Human Imaging Device Imaging technology Individual Intervention Lead Left Lesion Mitral Valve Mitral Valve Insufficiency Mitral Valve Prolapse Modeling Morbidity - disease rate Motion Operating Rooms Operative Surgical Procedures Outcome Pathologic Processes Patient Care Pattern Phenotype Ptosis Pulmonary Hypertension Series Solid Surgeon Techniques Test Result Testing Translating United States Validation Ventricular Visual base biomechanical engineering cardiac magnetic resonance imaging clinical application clinically relevant design experimental study flexibility heart function heart imaging hemodynamics improved in vivo innovation mortality novel operation pre-clinical preference preservation prototype reconstruction repair strategy repaired sensor sheep model standard of care

项目摘要

PROJECT SUMMARY Mitral valve regurgitation is one of the most prevalent valvular heart diseases worldwide and is a significant cause of global morbidity and mortality. Although mitral repair operations were first described several decades ago, numerous new repair techniques have been developed in recent years. However, these techniques were described primarily based on anatomic principles and guided by valvular appearance and function, mostly via visual assessment and echocardiography. The biomechanical engineering principles and fundamentals underlying various mitral valve repair techniques have rarely been investigated, and repair strategy remains largely based on surgeon’s preference. With evolving guidelines advocating earlier, more aggressive intervention with mitral valve repair whenever possible, especially for regurgitant lesions, the goal of this proposal is to establish a solid understanding of mitral valve repair biomechanics for primary mitral regurgitation. This is essential for optimizing these complex mitral valve repair operations to enhance valve repairability, expand valve repair technique adoptability, and improve repair durability. Aim 1 will characterize and optimize our novel 3D- printed mitral annuloplasty ring prototype with selective flexibility. Using healthy human cardiac MRI marker tracking and fatigue testing results, the annuloplasty ring design will be perfected to facilitate the native mitral annular motion and enhance durability. Next, primary mitral regurgitation models with leaflet prolapse and annular dilation will be created and assessed. Current clinically employed repair operations, namely triangular resection, neochordal reconstruction, and ring annuloplasty using our novel design and other annuloplasty rings with varying flexibility, will be tested on these primary mitral regurgitation models. Innovative biomechanical sensors and advanced cardiac imaging technologies will facilitate the detailed analysis of the engineering principles underlying these operations and annuloplasty ring designs. Aim 2 will validate findings from the ex vivo experiments in pre-clinical ovine models. The effect of annuloplasty rings’ flexibility on natural mitral annular motion and left ventricular vortex flow pattern after ring annuloplasty will be investigated in healthy ovine models without mitral regurgitation. The mitral valve repair operations will be evaluated on the ovine models with chronic primary mitral regurgitation generated by posterior leaflet chordal transection. The results will be compared to the ex vivo studies. The experiments proposed herein have great clinical applicability. Findings from this study can help surgeons gain substantial understanding of mitral valve repair biomechanics thereby translating directly to patient care in the operating room.

项目概要二尖瓣关闭不全是全世界最常见的瓣膜性心脏病之一，是一种严重的心脏瓣膜病。尽管二尖瓣修复手术在几十年前就已被首次描述。近年来，已经开发出许多新的修复技术，但是这些技术都已被淘汰。主要基于解剖学原理进行描述，并以瓣膜外观和功能为指导，主要通过视觉评估和超声心动图。生物力学工程原理和基础。各种二尖瓣修复技术的基础很少被研究，修复策略仍然存在很大程度上取决于外科医生的偏好，随着指南的不断发展，提倡更早、更积极的干预。尽可能进行二尖瓣修复，特别是对于反流病变，该提案的目标是对原发性二尖瓣反流的二尖瓣修复生物力学有深入的了解。对于优化这些复杂的二尖瓣修复操作至关重要，以增强瓣膜的可修复性、扩张瓣膜目标 1 将表征和优化我们的新型 3D-技术。使用健康人类心脏 MRI 标记打印具有选择性灵活性的二尖瓣环成形术环原型。跟踪和疲劳测试结果，瓣环成形环设计将得到完善，以方便原生二尖瓣接下来，原发性二尖瓣反流模型与小叶脱垂和增强。将创建和评估目前临床上使用的环形扩张手术，即三角手术。使用我们新颖的设计和其他瓣环成形术环进行切除、新索状体重建和环成形术具有不同的灵活性，将在这些创新的二尖瓣反流模型上进行测试。传感器和先进的心脏成像技术将有助于工程的详细分析这些手术和瓣环成形术环设计的基本原理将验证前人的发现。临床前绵羊模型的体内实验瓣环成形术环的灵活性对自然二尖瓣环的影响。将在健康绵羊模型中研究环成形术后的运动和左心室涡流模式没有二尖瓣反流的二尖瓣修复手术将在慢性羊模型上进行评估。后叶腱索横断产生的原发性二尖瓣关闭不全的结果将与本文提出的实验具有很大的临床适用性。可以帮助外科医生充分了解二尖瓣修复生物力学，从而直接转化到手术室的病人护理。