Ischemic mitral regurgitation (IMR) affects 1.6 to 2.8 million Americans and increases mortality even when mild. There is a strong graded relationship between the severity of IMR and reduced survival. Valve incompetence in IMR occurs due to a variable combination of leaflet tethering and annular dilation. Mitral valve (MV) repair with undersized annuloplasty rings has become the preferred treatment;however, while annuloplasty effectively addresses annular dilatation, it does not improve and may exacerbate leaflet tethering. MV repair is associated with a 30% recurrence rate of significant IMR (e2+) within 6 months after surgery. This high recurrence rate significantly limits the efficacy of MV repair for IMR. It is likely that a standardized and reliably efficacious surgical therapeutic approach to IMR will not be achievable until the confounding phenomena of recurrent mitral regurgitation can be better understood and subsequently neutralized. A patient-specific approach to treatment, guided by preoperative imaging-based risk stratification for recurrent IMR, is apt to be the best means for achieving this important goal. It is the intent of the proposed project to develop such a tool for risk stratification. The central hypothesis of this proposal is that the degree of pre-repair mitral leaflet tethering determines the degree of recurrent mitral regurgitation after ring annuloplasty for IMR. We further hypothesize that leaflet tethering can be effectively quantified preoperatively by echocardiography and that three-dimensional echocardiography (3DE) is superior to standard two-dimensional echocardiography (2DE) for predicting the degree of recurrent IMR. The proposed study seeks to develop echocardiographic techniques to predict, preoperatively, the degree of recurrent IMR that can be expected for an individual patient within the first year after surgery. The anticipated results of the proposed study will allow surgeons to determine which IMR patients are best treated with standard MV repair (i.e. ring annuloplasty) and which are better served by valve replacement. Such an approach will limit recurrent IMR and simultaneously maximize the number of patients who realize the benefits of MV repair. Both results will improve clinical outcomes. We propose to enroll 378 patients at three high-volume cardiac surgical centers over a 5 year period. Intraoperative 2DE and 3DE parameters will be correlated with the degree of recurrent IMR at 6 and 12 months after surgery.
This study seeks to develop echocardiographic-based analytic tool to predict, preoperatively, the degree of recurrent IMR after mitral valve repair surgery. The results of this study will allow surgeons to identify patients who are likely to fail mitral valve repair and who would be better served by valve replacement. This approach will limit recurrent IMR and simultaneously maximize the number of patients who realize the benefits of mitral valve repair.
|Bouma, Wobbe; Wijdh-den Hamer, Inez J; Gorman 3rd, Joseph H et al. (2018) Reply. Ann Thorac Surg 106:313|
|Pouch, Alison M; Aly, Ahmed H; Lai, Eric K et al. (2017) Spatiotemporal Segmentation and Modeling of the Mitral Valve in Real-Time 3D Echocardiographic Images. Med Image Comput Comput Assist Interv 10433:746-754|
|Bavo, A M; Pouch, A M; Degroote, J et al. (2017) Patient-specific CFD models for intraventricular flow analysis from 3D ultrasound imaging: Comparison of three clinical cases. J Biomech 50:144-150|
|Mahmood, Feroze; Knio, Ziyad O; Yeh, Lu et al. (2017) Regional Heterogeneity in the Mitral Valve Apparatus in Patients With Ischemic Mitral Regurgitation. Ann Thorac Surg 103:1171-1177|
|Schoonbeek, Rosanne C; Takebayashi, Satoshi; Aoki, Chikashi et al. (2016) Implantation of the Medtronic Harmony Transcatheter Pulmonary Valve Improves Right Ventricular Size and Function in an Ovine Model of Postoperative Chronic Pulmonary Insufficiency. Circ Cardiovasc Interv 9:|
|Pierce, Eric L; Gorman, Robert C; Gorman 3rd, Joseph H et al. (2016) Mitral annuloplasty ring suture dehiscence: In search of more robust techniques. J Thorac Cardiovasc Surg 152:1640|
|Gorman, Robert C; Bouma, Wobbe; Gorman 3rd, Joseph H (2016) Reply. Ann Thorac Surg 102:1414-5|
|Wijdh-den Hamer, Inez J; Bouma, Wobbe; Lai, Eric K et al. (2016) The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty. J Thorac Cardiovasc Surg 152:847-59|
|Contijoch, Francisco; Rogers, Kelly; Rears, Hannah et al. (2016) Quantification of Left Ventricular Function With Premature Ventricular Complexes Reveals Variable Hemodynamics. Circ Arrhythm Electrophysiol 9:e003520|
|Bouma, Wobbe; Lai, Eric K; Levack, Melissa M et al. (2016) Preoperative Three-Dimensional Valve Analysis Predicts Recurrent Ischemic Mitral Regurgitation After Mitral Annuloplasty. Ann Thorac Surg 101:567-75; discussion 575|
Showing the most recent 10 out of 88 publications