Mechanically Assisted Total Cavopulmonary Connection With an Axial Flow Pump: Computational and In Vivo Study

Gandolfo, Fabrizio; Brancaccio, Gianluca; Donatiello, Salvatore; Filippelli, Sergio; Perri, Gianluigi; Iannace, Enrico; D’Amario, Domenico; Testa, Genni; D’Avenio, Giuseppe; Grigioni, Mauro; Amodeo, Antonio

doi:10.1111/aor.12641

Cited by 20 publications

(25 citation statements)

References 20 publications

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“…ii. Approaches for handling of venous coronary flow, which drains into the RA, were analyzed and classified into two groups depending on whether the main PA was Mean (SD): 22.4 (1.5) Nawa et al 12 Mean (SD): 10.6 (1.75) Szabo et al 13 No data Szabo et al 14 Mean (SD): 22.3 (5.2) Tanoue et al 15 Mean (SD): 16.8 (2.7) Ovine Gandolfo et al 16 Range: 42.0-48.0 Koçyıldırım et al 17 Mean (SD): 65.0 (4.1) Myers et al 18 Mean (SD): 7.2 (1.1) Riemer et al 19 Range: 42.0-48.0 Rodefeld et al 20 Mean: 56.5; range: 33.0-78.6 Rodefeld et al 21 Mean (SD): 5.6 (1.5) Swartz et al 22 Mean (SD): 56.6 (5.7) Tsuda et al 23 Range: 47.0-57.0 Wang et al 24 Range: 35.0-45.0 Wang et al 25 Range: 35.0-45.0 Wang et al 26 Range: 35.0-45.0 Porcine Derk et al 27 Mean:50.7; range 44.0-61.0 Kanakis et al 28 Mean (SD): 43.0 (3.8) Klautz et al 29 Mean (SD): 28.3 (7.9) Macé et al 30 Mean (SD): 31.4 (4.0) Sinha et al 31 Mean: 25.0 Wei et al 32 Mean (SD): 8.8 (0.9)…”

Section: Surgical Classificationmentioning

confidence: 99%

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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BACKGROUND Long-term survival of patients with a single ventricle palliated with a Fontan procedure is still limited. No curative treatment options are available. To investigate the pathophysiology and potential treatment options, such as mechanical circulatory support (MCS), appropriate large animal models are required. The aim of this review was to analyze all full-text manuscripts presenting approaches for an extracardiac total cavopulmonary connection (TCPC) animal model to identify the feasibility and limitations in the acute and chronic setting. METHODS A literature search was performed for fulltext publications presenting large animal models with extracardiac TCPCs on Pubmed and Embase. Out of 454 reviewed papers, 23 manuscripts fulfilled the inclusion criteria. Surgical procedures were categorized and hemodynamic changes at the transition from the biventricular to the univentricular condition analyzed. RESULTS Surgical procedures varied especially regarding coronary venous flow handling and anatomic shape of the TCPC. In most studies (n = 14), the main pulmonary artery was clamped and the coronary venous flow redirected by additional surgical interventions. Only in five reports, the caval veins were connected to the right pulmonary artery to create a true TCPC shape, whereas in all others (n = 18), the veins were connected to the main pulmonary artery. An elevated pulmonary vascular resistance was identified as a limiting hemodynamic factor for TCPC completion in healthy animals. CONCLUSIONS A variety of acute TCPC animal models were successfully established with and without MCS, reflecting the most important hemodynamic features of a Fontan circulation; however, chronic animal models were not reported.

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Section: Surgical Classificationmentioning

confidence: 99%

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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“…However, clinical experience is limited to four patients, all of them non-ACHD. Currently, further devices are being designed specifically for the application in patients with end-stage CHD, numerically simulated and tested in animals (63).…”

Section: Mcs As Destination Therapy In Achdmentioning

confidence: 99%

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Hörer

2018

Cardiovasc. Diagn. Ther

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Today, more than two thirds of patients with congenital heart disease (CHD) are adults. Cardiac surgery plays an essential role in restoring and maintaining cardiac function, aside from evolving medical treatment and catheter-based interventions. The aim of the present publication was to describe the spectrum of operations performed on adults with CHD (ACHD) by reviewing current literature. Currently, surgery for ACHD is predominantly valve surgery, since valvular pathologies are often either a part of the basic heart defect or develop as sequelae of corrective or palliative surgery. Surgical techniques for valve repair, established in patients with acquired heart disease (non-ACHD), can often be transferred to ACHD. New valve substitutes may help to reduce the number of redo operations. Most of valve operations yield good results in terms of survival and quality of life, with the precondition that the ventricular function is preserved. Heart failure due to end-stage CHD is the most frequent cause of mortality in ACHD. However, surgical treatment by means of mechanical circulatory support (MCS) is still uncommon and the mortality exceeds the one following other operations in ACHD. Currently, different devices are used and new technical developments are in progress. However, there still is no ideal assist device available. Therefore, heart transplantation remains the only valid option for end-stage CHD. Despite higher early mortality following heart transplantation in ACHD compared to non-ACHD, the long-term survival compares favorably to non-ACHD. There is room for improvement by refining the indications, the time of listing, and the perioperative care of ACHD transplant patients. Sudden death is the second most frequent cause of mortality in ACHD. Ventricular tachycardia is the most frequent cause of sudden death followed by coronary artery anomaly. Due to the increasing awareness of physicians and the improved imaging techniques, coronary artery anomalies are coming more into the focus of cardiac surgeons. However, the reported experience is limited and it is currently difficult to provide a standardized and generally applicable recommendation for the indication and the adequate surgical technique. With the increasing age and complexity of ACHD, treatment of rhythm disturbances by surgical ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation and resynchronisation gains importance. A risk score specifically designed for surgery in ACHD is among the newest developments in predicting the outcome of surgical treatment of ACHD. This evidence-based score, derived from and validated with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database, enables comparison of risk-adjusted performance of the whole spectrum of procedures performed in ACHD and helps in understanding the differences in surgical outcomes. The score is thus a powerful tool for quality control and quality improvement. In conclusion, new developments in surgery for ACHD are currently made with regard to ...

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“…However, further research is needed to examine the risks associated with the modification of a left VAD to achieve lower pump speeds since such modifications can affect the reliability and stability of the device. Other methods for reducing the pressure generated by the pump such as trimming of the rotor blades [17] can also be further investigated in future studies.…”

Section: Discussionmentioning

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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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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Mechanically Assisted Total Cavopulmonary Connection With an Axial Flow Pump: Computational and In Vivo Study

Cited by 20 publications

References 20 publications

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

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

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