In Vitro Evaluation of an External Compression Device for Fontan Mechanical Assistance

Valdovinos, John; Shkolyar, Eugene; Carman, Gregory P.; Levi, Daniel S.

doi:10.1111/aor.12152

Cited by 19 publications

(22 citation statements)

References 26 publications

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“…The use of ventricular assist devices (VADs) in pediatrics is well established as a bridge to heart transplantation (HT). Moreover, mock circulations were developed to test and develop new assist devices (13,17). In addition, in a recent analysis of data from multiple children's hospitals in the USA, approximately 12% of all hospitalizations in children with SV are complicated by heart failure (2).…”

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confidence: 99%

Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study

et al. 2015

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The growing population of failing single-ventricle (SV) patients might benefit from ventricular assist device (VAD) support as a bridge to heart transplantation. However, the documented experience is limited to isolated case reports. Considering the complex and different physiopathology of Norwood, Glenn, and Fontan patients and the lack of established experience, the aim of this work is to realize and test a lumped parameter model of the cardiovascular system able to simulate SV hemodynamics and VAD implantation effects to support clinical decision. Hemodynamic and echocardiographic data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output and the mean arterial systemic pressure in all the three palliation conditions (Norwood 77.2 and 19.7%, Glenn 38.6 and 32.2%, and Fontan 17.2 and 14.2%); (ii) decreases the SV external work (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) decreases the pressure pulsatility index (Norwood 65.2%, Glenn 81.3%, and Fontan 64.8%); (iv) increases the pulmonary arterial pressure in particular in the Norwood circulation (Norwood 39.7%, Glenn 12.1% and Fontan 3%); and (v) decreases the atrial pressure (Norwood 2%, Glenn 10.6%, and Fontan 8.6%). Finally, the VAD work is lower in the Norwood circulation (30.4 mL·mm Hg) in comparison with Fontan (40.3 mL·mm Hg) and to Glenn (64.5 mL·mm Hg) circulations. The use of VAD in SV physiology could be helpful to bridge patients to heart transplantations by increasing the CO and unloading the SV with a decrement of the atrial pressure and the SV external work. The regulation of the pulmonary flow is challenging because the Pap is increased by the presence of VAD. The hemodynamic changes are different in the different SV palliation step. The use of numerical models could be helpful to support patient and VAD selection to optimize the clinical outcome.

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confidence: 99%

Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study

et al. 2015

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“…Finally, Valdovinos et al. evaluated the use of an external compression device for the cavopulmonary assistance in a mock circulation . To our knowledge, there are no data regarding the simulation of VAD implantation on Glenn and Norwood physiology and there are no data aimed at comparing the effects of different VAD cannulation strategies in Fontan physiology on the basis of different failing conditions.…”

Section: Discussionmentioning

confidence: 99%

“…From systemic arterial pressure waveforms, it was possible to evaluate the time decay that is the combination between resistances and compliances. From these time decay constants, it was possible to estimate the total arterial systemic compliance . Starting from the default pulmonary arterial compliance (Cap), the compliance value was decreased empirically to reach the measured systolic pulmonary arterial pressure (Pap).…”

Section: Methodsmentioning

confidence: 99%

“…For each section of the numeric model, the input flow is transmitted from the previous block, while the output flow and the generated pressure are calculated and transmitted to the next block. The model is implemented in Labview 7.1 (National Instrument, Austin, TX, USA) and equations are solved by Euler's method (17)(18)(19)(22)(23)(24). Table 1 shows the parameters default values, with the exception of R_f, Z_bt, and R_asd that are calculated for each patient.…”

Section: Numeric Modelmentioning

confidence: 99%

“…constants, it was possible to estimate the total arterial systemic compliance (17)(18)(19)(22)(23)(24). Starting from the default pulmonary arterial compliance (Cap), the compliance value was decreased empirically to reach the measured systolic pulmonary arterial pressure (Pap).…”

Section: Simulation Of Vads In Single Ventricle Physiologymentioning

confidence: 99%

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Use of Ventricular Assist Device in Univentricular Physiology: The Role of Lumped Parameter Models

et al. 2015

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Failing single-ventricle (SV) patients might benefit from ventricular assist devices (VADs) as a bridge to heart transplantation. Considering the complex physiopathology of SV patients and the lack of established experience, the aim of this work was to realize and test a lumped parameter model of the cardiovascular system, able to simulate SV hemodynamics and VAD implantation effects. Data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Additionally, both the effects of ventricular assistance and cavopulmonary assistance were simulated in different pathologic conditions on Fontan patients, including systolic dysfunction, diastolic dysfunction, and pulmonary vascular resistance increment. The model can reproduce patients' baseline well. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output (CO) in all the three palliation conditions (Norwood 77.2%, Glenn 38.6%, and Fontan 17.2%); (ii) decreases the SV external work (SVEW) (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) increases the mean pulmonary arterial pressure (Pap) (Norwood 39.7%, Glenn 12.1%, and Fontan 3%). In Fontan circulation, with systolic dysfunction, the left VAD (LVAD) increases CO (35%), while the right VAD (RVAD) determines a decrement of inferior vena cava pressure (Pvci) (39%) with 34% increment of CO. With diastolic dysfunction, the LVAD increases CO (42%) and the RVAD decreases the Pvci. With pulmonary vascular resistance increment, the RVAD allows the highest CO (50%) increment with the highest decrement of Pvci (53%). The single ventricular external work (SVEW) increases (decreases) increasing the VAD speed in cavopulmonary (ventricular) assistance. Numeric models could be helpful in this challenging and innovative field to support patients and VAD selection to optimize the clinical outcome and personalize the therapy.

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Early Development of a Fontan Assist Device

Md Khudzari,

Osman,

Aziz

et al. 2024

Lecture Notes in Bioengineering

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In Vitro Evaluation of an External Compression Device for Fontan Mechanical Assistance

Cited by 19 publications

References 26 publications

Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study

Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study

Use of Ventricular Assist Device in Univentricular Physiology: The Role of Lumped Parameter Models

Early Development of a Fontan Assist Device

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