Advances in Mitral Valve Therapy at Penn
Within the division of cardiac surgery, the
Gorman Cardiovascular Research Group (GCRG) has
become the focal point for the evolving synergy
between translational research and clinical practice – a
factor particularly apparent in the development
of novel diagnostic and therapeutic approaches
to the mitral valve that are unique to Penn.
Percutaneous Mitral Valve Repair and Replacement
The new but quickly expanding field of percutaneous
mitral valve repair and replacement is the
focus of intense research activity for the
GCRG. The Group has worked closely with outside
inventors, start ups and major device companies
on a variety of percutaneous mitral valve repair
projects.
Currently, the GCRG is collaborating with Endovalve
(a start up company founded at Penn and based
on the inventions of Penn cardiologist Howard
Herrmann, MD) to develop the first fully
percutaneous mitral valve replacement device.
(Figure 1)
Figure 1
Figure 1 – An illustration
of a percutaneously placed mitral
valve bioprosthesis currently being
developed at Penn in collaboration
with Endovalve Inc. The valve will
be placed using venous access and
a trans-atrial septal approach
(A) and will be anchored using
a novel bi-stable claw technology
(B). |
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Saddle Annuloplasty Ring
Combining mathematical models with sonomicrometry,
echocardio graphy, CT scan and MRI imaging,
GCRG scientists elucidated the three dimensional
shape of the mitral annulus, providing the
first quantitative in vivo assessment of annular
geometry.
Following this advance, the Gormans developed
a saddle annuloplasty ring that optimizes leaflet
curvature, reduces leaflet stress and – theoretically – increases
mitral valve repair durability (Figure 2). The
device will be available for clinical use in
early 2008 and will be introduced first at Penn.
Figure 2
Figure 2 – A decade
of scientific investigation and
modeling has elucidated the importance
of mitral annular shape on leaflet
curvature and stress profile. The
pictured annuloplasty ring was
designed and developed at Penn
in collaboration with Medtronic
to reduce leaflet stress and increase
mitral valve repair durability. |
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Three-Dimensional Cardiac Imaging
To create an accurate, quantifiable method of
three-dimensional cardiac imaging, GCRG investigators
have designed cutting edge software that quantifies
mitral annular, leaflet and chordal geometry
with a precision and resolution previously
unobtainable. Imaging parameters developed
during this work give surgeons, for the first
time, the ability to predict the long term
durability of their repairs at the time of
surgery. The group is currently working with
two major medical imaging companies to begin
bringing these advances to clinical applications.
Predictive Modeling Algorithms to Optimize
Mitral Repair
GCRG scientists are using their 3D image analysis
expertise as the basis for predictive modeling
algorithms that will allow surgeons to optimize
repair techniques using quantitative data rather
than surgical intuition. Ultimately, this work
will permit preoperative images to be used in
conjunction with interactive software to “test” various
leaflet resection and annuloplasty options in
order to more precisely plan and individualize
surgical strategies before the patient enters
the operating room.
Glenolden Research Laboratory
Cardiovascular clinicians and researchers at
Penn have demonstrated a synergistic expertise
in all aspects of mitral valve therapy, prompting
partnerships with leading industry developers
to bring devices to clinical application. The
success of these efforts to date has provided
the impetus for the University and the Health
System to create a state-of-the-art large animal
laboratory facility in Glenolden, PA.
This facility will be functional by October
2007 and will be able to accommodate 140 large
animals. It will be outfitted with four fully
equipped large animal operating rooms, a state
of the art cardiovascular catheterization lab,
3T MRI, and real-time 3D echocardiography.
“By
increasing our ability to do world
class translational research, the
Glenolden facility will aid in promoting
the reputation of Penn's cardiovascular
services from one of regional dominance
to that of a national referral center.”
– Joseph
H. Gorman, III, MD
Gorman Cardiovascular Research
Group
Hospital of the University of Pennsylvania |
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