Robert Gorman is a Professor of Surgery and Director of the Cardiac Surgical Research at the University of Pennsylvania. As a cardiac surgeon and engineer he commits 100% of his time to laboratory and clinical research as well as cardiovascular device development. His research has been focused in the field of structural heart disease with emphasis on post-infarction left ventricular remodeling, valvular heart disease, cardiovascular imaging and cardiovascular device development. The research project proposed in this application is the culmination of over two and half decades of work by the research group on the clinical problem of ischemic mitral regurgitation. Through the use of large animal models and clinical studies the group has made important and well-recognized contributions that have helped to elucidate the mechanism of IMR. The Gorman Cardiovascular Research Group has developed innovative new annuloplasty technologies that have been used clinically to treat IMR patients. Most importantly, Robert Gorman and the rest of the research group have focused attention among cardiac surgeons on the limitations of current surgical practice to effectively treat IMR patients and highlighted the need for a preoperative risk stratification approaches that will allow for patient-specific surgical planning capable of determining whether an individual patient would be better served by valve repair or valve replacement surgery.