Cavopulmonary Assist for the Failing Fontan Circulation

Giridharan, Guruprasad A.; Ising, Mickey S.; Sobieski, Michael A.; Koenig, Steven C.; Chen, Jun; Frankel, Steven; Rodefeld, Mark D.

doi:10.1097/mat.0000000000000135

Cited by 33 publications

(6 citation statements)

References 21 publications

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“…Through simulations, we showed that a proper implementation of an arterial pump in the right circulation could benefit the Fontan hemodynamics. We constructed the failing Fontan model employing clinical data available in the literature and found that the failing circulation model to be in general agreement with previous reports [16], [18], [35]. Our model sensitivity analysis showed the association of the hemodynamic parameters (e.g.…”

Section: Discussionsupporting

confidence: 84%

“…To our knowledge, there has been no study that directly assesses how the hemodynamics compare between these two surgical A concerted work is in progress to develop a cavopulmonary assist device as a bridge to cardiac transplantation or for longterm support. Researchers have suggested several prototypes for powering the Fontan circulation [14], [18]- [21]. While these prototypes are designed to be compatible with a lowpressure operating environment, they are not commercially available and thus not employed in the clinical management of single ventricle patients.…”

Section: Introductionmentioning

confidence: 99%

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Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Farahmand

Kavarana

Kung

2020

IEEE Trans. Biomed. Eng.

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Fontan patients often develop circulatory failure and are in desperate need of a therapeutic solution. A blood pump surgically placed in the cavopulmonary pathway can substitute the function of the absent sub-pulmonary ventricle by generating a mild pressure boost. However, there is currently no commercially available device designed for the cavopulmonary application; and the risks and benefits of implanting a ventricular assist device (VAD) originally designed for the left ventricular application on the right circulation of failing Fontan patients is not yet clear. Moreover, further research is needed to compare the hemodynamics between the two clinically-considered surgical configurations for cavopulmonary assist, with Full and IVC Support corresponding to the entire venous return or only the inferior venous return, respectively, being routed through the VAD. In this study, we used a numerical model of the failing Fontan physiology to evaluate the Fontan hemodynamic response to a left VAD during the IVC and Full support scenarios. We observed that during Full support the VAD improved the cardiac output while maintaining blood pressures within safe ranges, and lowered the IVC pressure to <15mmHg; however, we found a potential risk of lung damage at higher pump speeds due to the excessive pulmonary pressure elevation. IVC support, on the other hand, did not benefit the hemodynamics in the patient cases simulated, resulting in the superior vena cava pressure increasing to an unsafe level of >20 mmHg. The findings in this study may be helpful to surgeons for recognizing the risks of a cavopulmonary VAD and developing coherent clinical strategies for the implementation of cavopulmonary support. Index Terms-Ventricular assist device (VAD), lumped parameter network model, congenital heart disease, Fontan

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Farahmand

Kavarana

Kung

2020

IEEE Trans. Biomed. Eng.

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“…Various investigations have been performed on pediatric MCLs assembled with aortic models to evaluate the hemodynamic performance of these procedures ( Biglino et al, 2011 ; Biglino et al, 2012a ; Zhou et al, 2015 ; Hang et al, 2016 ). Among the surgical procedures, considerable researches have focused on the simulation of the Fontan procedure ( Haggerty et al, 2012 ; Giridharan et al, 2013 ; Kerlo et al, 2013 ; Vukicevic et al, 2013 ; Giridharan et al, 2014 ; Horvath et al, 2020 ), which has greatly improved patient survival and is the most effective treatment ( Kutty et al, 2020 ). Depending on the physiological features of the Fontan patient, the MCL has a single ventricle driving the whole MCL.…”

Section: Advanced MCL With Complex Circulations For Other I...mentioning

confidence: 99%

“…Depending on the physiological features of the Fontan patient, the MCL has a single ventricle driving the whole MCL. The ventricle can be pneumatically or hydraulically driven with a silicone chamber ( Rodefeld et al, 2010 ; Giridharan et al, 2013 ; Giridharan et al, 2014 ) or a VAD ( Vukicevic et al, 2013 ). Other components of Fontan -MCL normally include AOC, SVR, SVC, PAC, and pulmonary vascular resistance (PVR).…”

Section: Advanced MCL With Complex Circulations For Other I...mentioning

confidence: 99%

Mock circulatory loop applications for testing cardiovascular assist devices and in vitro studies

Gao

Wan³

et al. 2023

Front. Physiol.

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The mock circulatory loop (MCL) is an in vitro experimental system that can provide continuous pulsatile flows and simulate different physiological or pathological parameters of the human circulation system. It is of great significance for testing cardiovascular assist device (CAD), which is a type of clinical instrument used to treat cardiovascular disease and alleviate the dilemma of insufficient donor hearts. The MCL installed with different types of CADs can simulate specific conditions of clinical surgery for evaluating the effectiveness and reliability of those CADs under the repeated performance tests and reliability tests. Also, patient-specific cardiovascular models can be employed in the circulation of MCL for targeted pathological study associated with hemodynamics. Therefore, The MCL system has various combinations of different functional units according to its richful applications, which are comprehensively reviewed in the current work. Four types of CADs including prosthetic heart valve (PHV), ventricular assist device (VAD), total artificial heart (TAH) and intra-aortic balloon pump (IABP) applied in MCL experiments are documented and compared in detail. Moreover, MCLs with more complicated structures for achieving advanced functions are further introduced, such as MCL for the pediatric application, MCL with anatomical phantoms and MCL synchronizing multiple circulation systems. By reviewing the constructions and functions of available MCLs, the features of MCLs for different applications are summarized, and directions of developing the MCLs are suggested.

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“…A viscous impeller pump was introduced by Rodefeld et al for mechanical circulatory support in Fontan patients. Subsequent studies successfully compared CFD, PIV, and mock circuit results to assess blood damage, pressure rise, and cardiac function[63–65], and have compared left vs. right heart support in simulations and mock circulatory loops[66]. Mock circulatory experiments also examined the effect of adding a valve in the Fontan conduit in the presence of respiration, showing little change in cycle-averaged pressure, though the valve did function with higher pulmonary vascular resistance.…”

Section: Single Ventriclesmentioning

confidence: 99%

Computational modeling and engineering in pediatric and congenital heart disease

Marsden¹,

Feinstein

2015

Current Opinion in Pediatrics

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Purpose of review Recent methodological advances in computational simulations are enabling increasingly realistic simulations of hemodynamics and physiology, driving increased clinical utility. We review recent developments in the use of computational simulations in pediatric and congenital heart disease, describe the clinical impact in modeling in single ventricle patients, and provide an overview of emerging areas. Recent Findings Multiscale modeling combining patient specific hemodynamics with reduced order (i.e. mathematically and computationally simplified) circulatory models has become the defacto standard for modeling local hemodynamics and “global” circulatory physiology. We review recent advances that have enabled faster solutions, discuss new methods, (e.g. fluid structure interaction and uncertainty quantification), which lend realism both computationally and clinically to results, highlight novel computationally-derived surgical methods for single ventricle patients, and discuss areas in which modeling has begun to exert its influence including Kawasaki disease, fetal circulation, tetralogy of Fallot, (and pulmonary tree), and circulatory support. Summary Computational modeling is emerging as a crucial tool for clinical decision-making and evaluation of novel surgical methods and interventions in pediatric cardiology and beyond. Continued development of modeling methods, with an eye towards clinical needs, will enable clinical adoption in a wide range of pediatric and congenital heart diseases.

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Cavopulmonary Assist for the Failing Fontan Circulation

Cited by 33 publications

References 21 publications

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Mock circulatory loop applications for testing cardiovascular assist devices and in vitro studies

Computational modeling and engineering in pediatric and congenital heart disease

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