Surgery to Prevent Post Infarction Ventricular Remodeling

This project continues to be organized around the central hypothesis that mechanical sequelae of MI, infarct expansion (i.e. stretching), paradoxical systolic bulging (dyskinesia) and ischemic mitral regurgitation (IMR), alter regional myocardial stress distribution which in turn drive adverse left ventricular (LV) remodeling and lead to heart failure (HF). In previous funding cycles we have demonstrated that LV remodeling can be limited or reversed by mechanical infarct restraint that reduces infarct expansion and dyskinesia. During the next funding cycle we plan to conduct a series of innovative experiments that employ unique reactive and inert biomaterial technologies that will continue to improve our understanding of post-MI remodeling and move the concept of infarct restraint towards clinical reality for both the prevention post-MI remodeling (reactive materials) and as an adjunct to current surgical therapies for IMR (inert materials). We will continue to utilize our well-established, clinically relevant sheep models of post-MI remodeling. In addition, we will utilize a novel portfolio of laboratory-based and MRI-based techniques to serially assess infarct material properties, myocardial stress distribution, LV remodeling, LV function and tissue response parameters to quantitatively define the bio-mechanical mechanism of post-MI remodeling as well as the response to therapeutic intervention. The assembled team of engineers, surgeons and basic scientists has the expertise required to accomplish the proposed experiments as well as a long track record of productive collaboration in the area post-MI remodeling.