Concurrent use of continuous and pulsatile flow Ventricular Assist Device on a fontan patient: A simulation study

Abstract

The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the concurrent use of pulsatile (PVAD) and continuous flow (CVAD) ventricular assist device (VAD) on Fontan patients. Echocardiographic and hemodynamic data of five Fontan patients were retrospectively collected and used to simulate the patients' baseline hemodynamics. Then, for each patient, the following assistance modality was simulated for the cavopulmonary and the single ventricle (SV): (a) CVAD for cavopulmonary assistance (RCF) and PVAD assisting the SV (LCF) (RPF + LCF), (b) CVAD assisting SV and PVAD for cavopulmonary assistance (LPF + RCF). The numerical model can well reproduce patients' baseline. The cardiac output increases more importantly in the LCF + RPF configuration (35 vs. 8%). Ventricular volume decreases more evidently in the configuration LCF + RPF (28 vs. 6%), atrial pressure decreases in the LCF + RPF modality (10%), while it slightly increases in the RCF + LPF modality. The pulmonary arterial pressure slightly decreases (increases) in the configuration RCF + LPF (LCF + RPF). Ventricular external work increases in both configurations because of the total increment of the cardiac output. However, artero-ventricular coupling improves in both configurations: RCF + LPF-14%, LCF + RPF-41%. The pulsatility index decreases (increases) by 8% (13.8%) in the configuration LCF + RPF (RCF + LPF). A model could permit us to simulate extreme physiological conditions of the implantation of both CF and PF VAD on the Fontan patient and could permit to choose the proper VAD on the base of patients' condition. The configuration LCF + RPF seems to maximize the hemodynamic benefits.

Extracorporeal Membrane Oxygenation (ECMO) Support in Special Patient Populations—The Bidirectional Glenn and Fontan Circulations

“…Obviously, there is overlap in these patients and some present with both systolic and diastolic dysfunction. This has led to several groups exploring the use of a Cavopulmonary Assist Device (CPAD) to improve Fontan flow and increase ventricular preload in the setting of preserved systolic function ( 27 – 29 ). The goal would be to modestly improve and augment cavopulmonary pressure (by 2–5 mmHg), and thus improve ventricular filling and increase cardiac output.…”

Artificial Organs 2017: A Year in Review

“…Di Molfetta et al of Pediatric Hospital Bambino Gesù, Rome, Italy reported on the development and testing of a lumped parameter model of the cardiovascular system to simulate the concurrent use of pulsatile and continuous flow VAD on Fontan patients. Echocardiographic and hemodynamic data of five Fontan patients were retrospectively collected and used to simulate the patients’ baseline hemodynamics.…”

The hemodynamics and blood trauma in axial blood pump under different operating models

“…And it has also been shown that patients with VADs under modulation of speed have improved vascular pulsatility 7,12 . Di Molfetta et al established a complete cardiovascular lumped parameter model, which could be connected with pulsating pumps 13 . Ando et al conducted experiments on goats.…”

“…7,12 Di Molfetta et al established a complete cardiovascular lumped parameter model, which could be connected with pulsating pumps. 13 Ando et al conducted experiments on goats. Coronary flow was compared under constant pump speed, counter pulse mode, and co-pulse mode.…”