Evolution in Experimental Fontan Circulation: A Review

Kanakis, Meletios; Lioulias, Achilleas; Samanidis, George; Loukas, Constantinos; Mitropoulos, Fotios

doi:10.5761/atcs.ra.13-00017

Cited by 5 publications

(4 citation statements)

References 43 publications

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“…In this study, successful Fontan support was defined as the ability to simultaneously decrease IVC pressure (Fontan pressure) by 5 mm Hg and increase CO to 4.25 L/min (a 0.75 L/min increase) without increasing SVC pressure. [10][11][12] If these criteria were met, the FAD configuration was deemed successful. Identical failing Fontan baseline conditions were first established in each scenario.…”

Section: Experimental Protocolmentioning

confidence: 99%

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

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Tree

Maher

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Section: Experimental Protocolmentioning

confidence: 99%

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

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Maher

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Section: Experimental Protocolmentioning

confidence: 99%

In Vitro Examination of the VentriFlo True Pulse Pump for Failing Fontan Support

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Vincent³

et al. 2018

Artificial Organs

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The current methodology of Fontan palliation results in a one "pump" circulatory system with passive flow to the lungs. Inherent hemodynamic differences exist between a biventricular circulatory system and this modified physiology, leading to a host of long-term complications. Mechanical circulatory support (MCS) is a potential option to combat these pathophysiological conditions. In this study, we examine the VentriFlo True Pulse Pump as a MCS option to support a failing Fontan patient. An in vitro circulatory loop was used to model a failing Fontan patient, reproducing pathophysiological pressures and flow rates. The VentriFlo True Pulse Pump was positioned as a right sided support, testing multiple cannulation and baffle restriction strategies, as well as various pumping parameters including flow rate, frequency, stroke volume and the ejection to filling time ratio. A 10 mm Hg decrease in IVC pressure and 0.75 L/min increase in cardiac output were achieved using a complete baffle restriction strategy. Additional cannulation and banding strategies were not as successful. Pump flow rate and frequency significantly impacted hemodynamics, while the ejection to filling time ratio did not. Though not ideal, complete baffle restriction was necessary to achieve successful support. The ability to tune individual pumping parameters for a given MCS device will have a substantial impact on the pressures and flow augmentation seen in a Fontan circulation. Both future pump design and off-label VADs for Fontan use should consider the pump configuration and parameter combinations presented here, which offered successful support. Key Words: Congenital heart disease-Fontan-Mechanical circulatory support-Single ventricle-Ventricular assist device.The current methodology of Fontan palliation results in a one "pump" circulatory system with passive, nonpulsatile flow to the lungs. Inherent hemodynamic differences exist between a biventricular circulatory system and this modified physiology, including elevated central venous pressures (CVP) and insufficient cardiac output (CO), as well as a myriad of ventricular function, impedance and congestion issues (1-5). As these patients survive into early adulthood, numerous long-term complications are common, with liver disease, protein losing enteropathy and plastic bronchitis among the most prevalent (3,(6)(7)(8)(9).In order to moderate these long-term problems, a circulatory correction rather than palliation is needed; and with a limited number of immediate heart transplants available, mechanical circulatory support (MCS) has become a potential option as a bridge-to-transplant therapy. However, the use of MCS in Fontan patients poses unique challenges including low preload and afterload, an absent upstream capacitance chamber, and potentially difficult anatomic implementation (10).The two approaches for Fontan MCS include (i) designing a new pump specifically for Fontan use, or (ii) using an existing pump off-label with the hope that it can provide adequate support in an environment othe...

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“…Experimental studies that recapitulate single-ventricle physiology (SVP) are extremely challenging and technically difficult. No researchers have successfully achieved single-ventricle circulation in small animals, and a large chronic animal model has not been established even for the use of ventricular assist devices in the postnatal heart [ 3 ]. Therefore, our goal was to establish novel animal models of single-ventricle circulation in pigs to assess surgical palliation-specific haemodynamics during the creation of single-ventricle circulation, allowing the development of a new cell transplant strategy and outcome evaluation of stem cell distribution with respect to the route of delivery.…”

Section: Introductionmentioning

confidence: 99%

Intravenous infusion of cardiac progenitor cells in animal models of single ventricular physiology

Goto,

Ousaka,

Hirai

et al. 2023

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The goal of this study was to identify the practical applications of intravenous cell therapy for single-ventricle physiology (SVP) by establishing experimental SVP models. METHODS An SVP with a three-stage palliation was constructed in an acute swine model without cardiopulmonary bypass. A modified Blalock–Taussig (MBT) shunt was created using an aortopulmonary shunt with the superior and inferior venae cavae (SVC and IVC, respectively) connected to the left atrium (n = 10). A bidirectional cavopulmonary shunt (BCPS) was constructed using a graft between the IVC and the left atrium with an SVC cavopulmonary connection (n = 10). The SVC and the IVC were connected to the pulmonary artery to establish a total cavopulmonary connection (TCPC, n = 10). The survival times of half of the animal models were studied. The other half and the biventricular sham control (n = 5) were injected intravenously with cardiosphere-derived cells (CDCs), and the cardiac retention of CDCs was assessed after 2 h. RESULTS All SVP models died within 20 h. Perioperative mortality was higher in the BCPS group because of lower oxygen saturation (P < 0.001). Cardiac retention of intravenously delivered CDCs, as detected by magnetic resonance imaging and histologic analysis, was significantly higher in the modified Blalock-Taussig and BCPS groups than in the TCPC group (P < 0.01). CONCLUSIONS Without the total right heart exclusion, stage-specific SVP models can be functionally constructed in pigs with stable outcomes. Intravenous CDC injections may be applicable in patients with SVP before TCPC completion, given that the initial lung trafficking is efficiently bypassed and sufficient systemic blood flow is supplied from the single ventricle.

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Evolution in Experimental Fontan Circulation: A Review

Cited by 5 publications

References 43 publications

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

In Vitro Examination of the VentriFlo True Pulse Pump for Failing Fontan Support

Intravenous infusion of cardiac progenitor cells in animal models of single ventricular physiology

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