As experience has increased, surgeons have come to view mitral valve repair as the treatment of choice in patients with mitral regurgitation (MR) due to myxomatous leaflet degeneration and ischemic mitral regurgitation (IMR). However, recent long-term studies have indicated that the recurrence of significant MR after repair is much higher than previously believed, particularly in patients with IMR. The majority of repair failures are stress related. Leaflet curvature is an important determinant of valve stress. Therefore, repair devices and techniques which maximize leaflet curvature should reduce valvular stress and increase repair durability. During the previous funding cycle we proved the hypothesis that saddle shaped annuloplasty accentuates leaflet curvature when compared to flat annuloplasty in an ovine repair model. We have developed software algorithms that allow the use of real- time three dimensional echocardiography (rt-3DE) to non-invasively assess annular and leaflet geometry. This work has been very productive and has stimulated great interest in both the field of annuloplasty ring design and the field of quantitative rt-3DE imaging.
Our specific aim i s to evaluate the growing number of complex repair techniques being proposed to improve the currently poor results of IMR repair. We will study these techniques in an ovine model of IMR using our newly developed rt-3DE imaging algorithms. Each repair will be evaluated regarding its effect on leaflet curvature, leaflet tethering, ventricular function and durability. Such an assessment will allow only the most promising techniques to be performed in humans.

Public Health Relevance

The specific aim of the current proposal is to evaluate the growing number of annular, leaflet and subannular repair techniques being proposed (without any true evidence of efficacy) to improve the currently poor clinical results of ischemic mitral regurgitation (IMR) repair. We will evaluate the efficacy of these techniques in an ovine model of IMR repair using our previously develop 3D echo imaging algorithms. Such an assessment will allow only the most promising techniques to be performed in humans.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Bioengineering, Technology and Surgical Sciences Study Section (BTSS)
Program Officer
Sopko, George
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
Schools of Medicine
United States
Zip Code
McGarvey, Jeremy R; Kondo, Norihiro; Witschey, Walter R T et al. (2015) Injectable microsphere gel progressively improves global ventricular function, regional contractile strain, and mitral regurgitation after myocardial infarction. Ann Thorac Surg 99:597-603
Lee, Chung-Hao; Amini, Rouzbeh; Gorman, Robert C et al. (2014) An inverse modeling approach for stress estimation in mitral valve anterior leaflet valvuloplasty for in-vivo valvular biomaterial assessment. J Biomech 47:2055-63
McGarvey, Jeremy R; Shimaoka, Toru; Takebayashi, Satoshi et al. (2014) Minimally invasive delivery of a novel direct epicardial assist device in a porcine heart failure model. Innovations (Phila) 9:16-21
Jassar, Arminder S; Vergnat, Mathieu; Jackson, Benjamin M et al. (2014) Regional annular geometry in patients with mitral regurgitation: implications for annuloplasty ring selection. Ann Thorac Surg 97:64-70
Witschey, Walter R T; Pouch, Alison M; McGarvey, Jeremy R et al. (2014) Three-dimensional ultrasound-derived physical mitral valve modeling. Ann Thorac Surg 98:691-4
Pouch, Alison M; Vergnat, Mathieu; McGarvey, Jeremy R et al. (2014) Statistical assessment of normal mitral annular geometry using automated three-dimensional echocardiographic analysis. Ann Thorac Surg 97:71-7
Macarthur Jr, John W; Cohen, Jeffrey E; McGarvey, Jeremy R et al. (2014) Preclinical evaluation of the engineered stem cell chemokine stromal cell-derived factor 1* analog in a translational ovine myocardial infarction model. Circ Res 114:650-9
Aggarwal, Ankush; Ferrari, Giovanni; Joyce, Erin et al. (2014) Architectural trends in the human normal and bicuspid aortic valve leaflet and its relevance to valve disease. Ann Biomed Eng 42:986-98
Pouch, A M; Wang, H; Takabe, M et al. (2014) Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling. Med Image Anal 18:118-29
Vergnat, Mathieu; Levack, Melissa M; Jackson, Benjamin M et al. (2013) The effect of surgical and transcatheter aortic valve replacement on mitral annular anatomy. Ann Thorac Surg 95:614-9

Showing the most recent 10 out of 58 publications