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Penn Medicine Mitral Group

Cardiovascular physicians (surgeons, cardiologists and anesthesiologists) at Penn Medicine are recognized as leaders in complex cardiac care, and have established a commanding share of valve surgery market both locally and regionally. This dominance is the result of expertise in translational science, imaging, diagnosis and surgical techniques. The currently this productive group is developing strategies to exploit the recent advances in cardiovascular imagining and valve repair/replacement technology to propel Penn Medicine to a position international dominance in valve therapy.

Treatment of valvular heart disease is in the early stages of a major paradigm shift. Three dimensional echocardiographic imaging in conjunction with minimally invasive and transcatheter valve repair/replacement techniques (treatment of diseased heart valves by delivering a prosthetic valve/repair device using a catheter introduced via a peripheral blood vessel) are on the verge of greatly expanding the valve therapy market. Transcatheter aortic valve replacement is now generally available in Europe and at selected clinical trial sights in the United States (Penn is a trial center). It is expected that these devices will be widely available in the US between 2010 and 2011. The estimated market opportunity for transcatheter aortic valve replacement is predicted to exceed 1 billion dollars per year by 2014. Additionally, there are emerging technologies (several being developed here at Penn) that will facilitate transcatheter replacement of the mitral valve in the near future. Mitral regurgitation is a vastly underserved market with the potential to far surpass aortic valve replacement in terms of both procedures and revenue. It is expected that a percutaneous mitral valve replacement technology will expand the national market for mitral valve replacement to at least 350,000 cases/year (10 fold increase over current volume).

The mission of the Penn Medicine Mitral Group is to facilitate the integration of clinical prowess of the division of cardiac surgery with the expanding research endeavors of the Gorman Cardiovascular Research Group (GCRG). The GCRG has been leader in the development of both three dimensional echocardiography and percutaneous valve repair and replacement technology. Translation of the groups development work into important clinical application will allow Penn Medicine to assume an unsurpassed ability to offering state of the art care first during the next decade.

Below is a list of valve related research being carried out currently at the GCRG:
  1. Development of percutaneous and minimally invasive surgical devices for treating mitral valve disease. The group is actively involved in developing several concepts that will ultimately allow repair or replacement of the mitral valve using a small incision without cardiopulmonary bypass. The ultimate goal of this work is to create repair and replacement devices that can be delivered using a catheter and no incision at all.
  1. Development of the newest generation of mitral valve annuloplasty ring repair devices. In April 2008 the first Medtronic Profile 3D annuloplasty rings were used in mitral valve repair procedures at the operating rooms of the Hospital of the University of Pennsylvania. These procedures represented the culmination of over a decade of translational research work by the GCRG. The Profile 3D ring is design to reproduce the complex saddle shape of the human mitral valve annulus. The concept of saddle-shaped mitral annuloplasty was first proposed by the group in the mid 1990’s as mechanism to reduce valve strain and increase repair durability. To design the ring and prove its efficacy the group developed novel echocardiographic imaging software and leveraged relationships with Medtronic and Philip Medical Imaging. The project is a prime example of how collaboration between academia and industry can be use to develop basic scientific insights into practical medical devices that improve patient care.
  1. 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. The group is currently working with two major medical imaging companies to begin bringing these advances to clinical applications.
  1. Mitral Valve Stress Analysis. Computer scientists and engineers at the GCRG have been developing progressively more complex software for the quantitative interpretation of 3D cardiovascular imaging. The team working on real-time 3D echocardiography has now developed algorithms that can routinely construct end systolic stress maps for human mitral valves imaged in the operating room. While the work has already shed light on mechanisms of valve failure the ultimate goal for future iterations of the software is to provide surgeons with an interactive tool to help them plan mitral valve repair procedures and engineers with a means for developing repair devices
  1. Predictive Modeling Algorithms to Optimize and Teach Mitral Repair techniques. 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. These algorithms and imaging techniques will also be helpful in teaching established surgeons and resident new mitral valve repair techniques.
  1. Anti-calcification treatments to enhance bio-prosthetic valve durability. Currently the durability of bio-prosthetic tissue valves is very limited in younger patients due to a strong calcification stimulus. The GCRG in collaboration with scientists at CHOP are developing novel biochemical treatments that prevent valve calcification. The goal of the work is to develop tissue valves that can be placed in young people. Such an advance would free these patients from the morbidly of anti-coagulation currently required for the mechanical valves used to treat them.
  1. Novel Approaches to the treatment of children with congenital heart disease and pulmonary insufficiency. In collaboration with interventional cardiologists at CHOP the GCRG has developed a large animal model of pulmonary insufficiency. The group is using the model to develop new procedures and devices to treat children with failing tetralogy of Fallot repairs without the need for surgery.
 
MRI of Sheep Heart Video

Established in the early 90’s, our laboratory has been focused on the pathophysiological development of congestive heart failure (CHF). CHF Now affects over 30 million people in the US and has the potential to reach epidemic proportions. Dr. Joseph and Robert Gorman are

nationally recognized for their contributions to our current understanding of CHF at the mechanical, cellular, biochemical and molecular level. Our laboratory has previously established an animal models for CHF in large (sheep) and small animals (rabbits) that are reproducible, reliable and most importantly clinically relevant.

Areas of Expertise

  
  Heart Failure  
  Mitral Valve Disese  
  Advanced Cardiac Imaging  
  Blood-Surface Interface Interactions  

Our animal models are now referenced and utilized as benchmarks in the field of CHF research. The tremendous reproducibility offered by our models has allowed us to investigate and establish the pathophysiological process of post-infarction ventricular remodeling– now recognized as the crux in the development of CHF. In addition, the broad based expertise of our lab members allows cross-fertilization of ideas amongst cardiologists, surgeons, radiologists,, physiologists, engineers and molecular biologists. The result has been extensive and varied contributions to the literature that encompass a more global understanding of this pathological process. We have further enhanced our understanding by developing and utilizing advanced non-invasive diagnostic tools such as 3D echocardiography and also MRI based regional wall motion abnormalities–these laboratory techniques not only enhance our research effort but also hold tremendous clinical promise in their own right.

Our laboratory has also been the leader in understanding the contribution of mitral regurgitation in the development of CHF. Not surprisingly, in addition to our own NIH and nationally funded ongoing studies, our laboratory is actively sought out by manufacturers and research sponsors to help design and test therapies (such as stem cell transplantation) and as well as devices and procedures (such as novel annuloplasty ring designs, and percutaneous approaches to mitral valve repair). Our knowledge and expertise of CHF continues to develop, allowing us to design and carry out even more sophisticated investigations directed now at preventing or reversing this pathological process.
 



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