1
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Sahni A, Marshall L, Cetatoiu MA, Davee J, Schulz N, Eickhoff ER, St Clair N, Ghelani S, Prakash A, Hammer PE, Hoganson DM, Del Nido PJ, Rathod RH, Govindarajan V. Biomechanical Analysis of Age-Dependent Changes in Fontan Power Loss. Ann Biomed Eng 2024; 52:2440-2456. [PMID: 38753109 DOI: 10.1007/s10439-024-03534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/02/2024] [Indexed: 08/17/2024]
Abstract
The hemodynamics in Fontan patients with single ventricles rely on favorable flow and energetics, especially in the absence of a subpulmonary ventricle. Age-related changes in energetics for extracardiac and lateral tunnel Fontan procedures are not well understood. Vorticity (VOR) and viscous dissipation rate (VDR) are two descriptors that can provide insights into flow dynamics and dissipative areas in Fontan pathways, potentially contributing to power loss. This study examined power loss and its correlation with spatio-temporal flow descriptors (vorticity and VDR). Data from 414 Fontan patients were used to establish a relationship between the superior vena cava (SVC) to inferior vena cava (IVC) flow ratio and age. Computational flow modeling was conducted for both extracardiac conduits (ECC, n = 16) and lateral tunnels (LT, n = 25) at different caval inflow ratios of 2, 1, and 0.5 that corresponded with ages 3, 8, and 15+. In both cohorts, vorticity and VDR correlated well with PL, but ECC cohort exhibited a slightly stronger correlation for PL-VOR (>0.83) and PL-VDR (>0.89) than that for LT cohort (>0.76 and > 0.77, respectively) at all ages. Our data also suggested that absolute and indexed PL increase (p < 0.02) non-linearly as caval inflow changes with age and are highly patient-specific. Comparison of indexed power loss between our ECC and LT cohort showed that while ECC had a slightly higher median PL for all 3 caval inflow ratio examined (3.3, 8.3, 15.3) as opposed to (2.7, 7.6, 14.8), these differences were statistically non-significant. Lastly, there was a consistent rise in pressure gradient across the TCPC with age-related increase in IVC flows for both ECC and LT Fontan patient cohort. Our study provided hemodynamic insights into Fontan energetics and how they are impacted by age-dependent change in caval inflow. This workflow may help assess the long-term sustainability of the Fontan circulation and inform the design of more efficient Fontan conduits.
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Affiliation(s)
- A Sahni
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - L Marshall
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - M A Cetatoiu
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - J Davee
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - N Schulz
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - E R Eickhoff
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - N St Clair
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - S Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - A Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - P E Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - D M Hoganson
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - P J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - R H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Vijay Govindarajan
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Surgery, Harvard Medical School, Boston, MA, USA.
- Department of Internal Medicine (Cardiology), The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Pradegan N, Lena T, Tessari C, Gallo M, Tarzia V, Guariento A, Padalino M, Vida V, Gerosa G. Current Understanding and Future Directions of Transcatheter Devices to Assist Failing Fontan. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101334. [PMID: 39130169 PMCID: PMC11307829 DOI: 10.1016/j.jscai.2024.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 08/13/2024]
Abstract
Even if the Fontan operation is the surgical treatment of choice in patients with univentricular physiology, it remains a palliative strategy. Consequently, when Fontan patients reach adulthood, the majority of them develop late clinical sequelae of a failing cavo-pulmonary circuit (eg, liver failure, protein-losing enteropathy, and arrhythmias). Although heart transplantation represents the gold standard to treat this condition, Fontan patients usually accede to this therapy late, when risk of mortality is significantly increased, and a shortage of donor hearts limits transplantation in this special population. Mechanical circulatory support is an emerging field, but it is still in the experimental stage. Current mechanical circulatory devices have been used in Fontan circulation but are associated with the need for high-risk redo surgery. Percutaneous pumps are an emerging field that is still under investigation, with multiple prototypes developed. This review aims to analyze the hemodynamic profile of the developed intravascular pumps and their application in the preclinical scenario in the Fontan circulation.
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Affiliation(s)
- Nicola Pradegan
- Cardiac Surgery Unit, Heart Transplant and MCS Program, Cardio-thoracic-vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Tea Lena
- Cardiac Surgery Unit, Heart Transplant and MCS Program, Cardio-thoracic-vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Chiara Tessari
- Cardiac Surgery Unit, Heart Transplant and MCS Program, Cardio-thoracic-vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Michele Gallo
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Vincenzo Tarzia
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular and Public Health Department, University of Padova, Podova, Italy
| | - Alvise Guariento
- Pediatric Cardiac Surgery and Congenital Heart Disease Unit, Cardio-Thoracic-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Massimo Padalino
- Pediatric Cardiac Surgery and Congenital Heart Disease Unit, Cardio-Thoracic-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Vladimiro Vida
- Pediatric Cardiac Surgery and Congenital Heart Disease Unit, Cardio-Thoracic-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Heart Transplant and MCS Program, Cardio-thoracic-vascular and Public Health Department, Padova University Hospital, Padova, Italy
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3
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Rasooli R, Holmstrom H, Giljarhus KET, Jolma IW, Vinningland JL, de Lange C, Brun H, Hiorth A. In vitro hemodynamic performance of a blood pump for self-powered venous assist in univentricular hearts. Sci Rep 2024; 14:6941. [PMID: 38521832 PMCID: PMC10960831 DOI: 10.1038/s41598-024-57269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
Univentricular heart anomalies represent a group of severe congenital heart defects necessitating early surgical intervention in infancy. The Fontan procedure, the final stage of single-ventricle palliation, establishes a serial connection between systemic and pulmonary circulation by channeling venous return to the lungs. The absence of the subpulmonary ventricle in this peculiar circulation progressively eventuates in failure, primarily due to chronic elevation in inferior vena cava (IVC) pressure. This study experimentally validates the effectiveness of an intracorporeally-powered venous ejector pump (VEP) in reducing IVC pressure in Fontan patients. The VEP exploits a fraction of aortic flow to create a jet-venturi effect for the IVC, negating the external power requirement and driveline infections. An invitro Fontan mock-up circulation loop is developed and the impact of VEP design parameters and physiological conditions is assessed using both idealized and patient-specific total cavopulmonary connection (TCPC) phantoms. The VEP performance in reducing IVC pressure exhibited an inverse relationship with the cardiac output and extra-cardiac conduit (ECC) size and a proportional relationship with the transpulmonary pressure gradient (TPG) and mean arterial pressure (MAP). The ideal VEP with fail-safe features provided an IVC pressure drop of 1.82 ± 0.49, 2.45 ± 0.54, and 3.12 ± 0.43 mm Hg for TPG values of 6, 8, and 10 mm Hg, respectively, averaged over all ECC sizes and cardiac outputs. Furthermore, the arterial oxygen saturation was consistently maintained above 85% during full-assist mode. These results emphasize the potential utility of the VEP to mitigate elevated venous pressure in Fontan patients.
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Affiliation(s)
- Reza Rasooli
- Department of Energy Resources, Faculty of Science and Technology, University of Stavanger, 4036, Stavanger, Norway.
| | - Henrik Holmstrom
- Department of Pediatric Cardiology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Erik Teigen Giljarhus
- Department of Mechanical and Structural Engineering and Materials Science, University of Stavanger, 4036, Stavanger, Norway
| | - Ingunn Westvik Jolma
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, 4036, Stavanger, Norway
| | | | - Charlotte de Lange
- Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Brun
- Department of Pediatric Cardiology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Section for Medical Cybernetics and Image Processing, The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Aksel Hiorth
- Department of Energy Resources, Faculty of Science and Technology, University of Stavanger, 4036, Stavanger, Norway
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Şişli E, Yıldırım C, Aka İB, Tuncer ON, Atay Y, Özbaran M, Pekkan K. Switching the Left and the Right Hearts: A Novel Bi-ventricle Mechanical Support Strategy with Spared Native Single-Ventricle. Ann Biomed Eng 2023; 51:2853-2872. [PMID: 37635154 DOI: 10.1007/s10439-023-03348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
End-stage Fontan patients with single-ventricle (SV) circulation are often bridged-to-heart transplantation via mechanical circulatory support (MCS). Donor shortage and complexity of the SV physiology demand innovative MCS. In this paper, an out-of-the-box circulation concept, in which the left and right ventricles are switched with each other is introduced as a novel bi-ventricle MCS configuration for the "failing" Fontan patients. In the proposed configuration, the systemic circulation is maintained through a conventional mechanical ventricle assist device (VAD) while the venous circulation is delegated to the native SV. This approach spares the SV and puts it to a new use at the right-side providing the most-needed venous flow pulsatility to the failed Fontan circulation. To analyze its feasibility and performance, eight SV failure modes have been studied via an established multi-compartmental lumped parameter cardiovascular model (LPM). Here the LPM model is experimentally validated against the corresponding pulsatile mock-up flow loop measurements of a representative 15-year-old Fontan patient employing a clinically-approved VAD (Medtronic-HeartWare). The proposed surgical configuration maintained the healthy cardiac index (3-3.5 l/min/m2) and the normal mean systemic arterial pressure levels. For a failed SV with low ejection fraction (EF = 26%), representing a typical systemic Fontan failure, the proposed configuration enabled a ~ 28 mmHg amplitude in the venous/pulmonary waveforms and a 2 mmHg decrease in the central venous pressure (CVP) together with acceptable mean pulmonary artery pressures (17.5 mmHg). The pulmonary vascular resistance (PVR)-SV failure case provided a ~ 5 mmHg drop in the CVP, with venous/pulmonary pulsatility reaching to ~ 22 mmHg. For the high PVR failure case with a healthy SV (EF = 44%) pulmonary hypertension is likely to occur as expected. While this condition is routinely encountered during the heart transplantation and managed through pulmonary vasodilators a need for precise functional assessment of the spared failed-ventricle is recommended if utilized in the PVR failure mode. Comprehensive in vitro and in silico results encourage this novel concept as a low-cost, more physiological alternative to the conventional bi-ventricle MCS pending animal experiments.
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Affiliation(s)
- Emrah Şişli
- Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Osmangazi University Faculty of Medicine, Büyükdere District, Campus of Meşelik, Tepebaşı, 26480, Eskisehir, Turkey.
| | - Canberk Yıldırım
- Department of Biomedical Sciences and Engineering, Koç University, Istanbul, Turkey
| | - İbrahim Başar Aka
- Department of Mechatronics Engineering, İstanbul Bilgi University, Istanbul, Turkey
| | - Osman Nuri Tuncer
- Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Özbaran
- Heart Transplantation, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kerem Pekkan
- Department of Mechanical Engineering, Koç University, Rumeli Feneri Campus, Sarıyer, Istanbul, Turkey.
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Rasooli R, Giljarhus KET, Hiorth A, Jolma IW, Vinningland JL, de Lange C, Brun H, Holmstrom H. In Silico Evaluation of a Self-powered Venous Ejector Pump for Fontan Patients. Cardiovasc Eng Technol 2023; 14:428-446. [PMID: 36877450 PMCID: PMC10412470 DOI: 10.1007/s13239-023-00663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The Fontan circulation carries a dismal prognosis in the long term due to its peculiar physiology and lack of a subpulmonic ventricle. Although it is multifactorial, elevated IVC pressure is accepted to be the primary cause of Fontan's high mortality and morbidity. This study presents a self-powered venous ejector pump (VEP) that can be used to lower the high IVC venous pressure in single-ventricle patients. METHODS A self-powered venous assist device that exploits the high-energy aortic flow to lower IVC pressure is designed. The proposed design is clinically feasible, simple in structure, and is powered intracorporeally. The device's performance in reducing IVC pressure is assessed by conducting comprehensive computational fluid dynamics simulations in idealized total cavopulmonary connections with different offsets. The device was finally applied to complex 3D reconstructed patient-specific TCPC models to validate its performance. RESULTS The assist device provided a significant IVC pressure drop of more than 3.2 mm Hg in both idealized and patient-specific geometries, while maintaining a high systemic oxygen saturation of more than 90%. The simulations revealed no significant caval pressure rise (< 0.1 mm Hg) and sufficient systemic oxygen saturation (> 84%) in the event of device failure, demonstrating its fail-safe feature. CONCLUSIONS A self-powered venous assist with promising in silico performance in improving Fontan hemodynamics is proposed. Due to its passive nature, the device has the potential to provide palliation for the growing population of patients with failing Fontan.
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Affiliation(s)
- Reza Rasooli
- Department of Energy Resources, Faculty of Science and Technology, University of Stavanger, 4036, Stavanger, Norway.
| | - Knut Erik Teigen Giljarhus
- Department of Mechanical and Structural Engineering and Materials Science, University of Stavanger, 4036, Stavanger, Norway
| | - Aksel Hiorth
- Department of Energy Resources, Faculty of Science and Technology, University of Stavanger, 4036, Stavanger, Norway
| | - Ingunn Westvik Jolma
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, 4036, Stavanger, Norway
| | | | - Charlotte de Lange
- Department of Paediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Brun
- Section for Medical Cybernetics and Image Processing, The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Paediatric Cardiology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrom
- Department of Paediatric Cardiology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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6
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Moradi H, Al-Hourani A, Concilia G, Khoshmanesh F, Nezami FR, Needham S, Baratchi S, Khoshmanesh K. Recent developments in modeling, imaging, and monitoring of cardiovascular diseases using machine learning. Biophys Rev 2023; 15:19-33. [PMID: 36909958 PMCID: PMC9995635 DOI: 10.1007/s12551-022-01040-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular diseases are the leading cause of mortality, morbidity, and hospitalization around the world. Recent technological advances have facilitated analyzing, visualizing, and monitoring cardiovascular diseases using emerging computational fluid dynamics, blood flow imaging, and wearable sensing technologies. Yet, computational cost, limited spatiotemporal resolution, and obstacles for thorough data analysis have hindered the utility of such techniques to curb cardiovascular diseases. We herein discuss how leveraging machine learning techniques, and in particular deep learning methods, could overcome these limitations and offer promise for translation. We discuss the remarkable capacity of recently developed machine learning techniques to accelerate flow modeling, enhance the resolution while reduce the noise and scanning time of current blood flow imaging techniques, and accurate detection of cardiovascular diseases using a plethora of data collected by wearable sensors.
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Affiliation(s)
- Hamed Moradi
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Akram Al-Hourani
- School of Engineering, RMIT University, Melbourne, Victoria Australia
| | | | - Farnaz Khoshmanesh
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria Australia
| | - Farhad R. Nezami
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Scott Needham
- Leading Technology Group, Melbourne, Victoria Australia
| | - Sara Baratchi
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria Australia
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7
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Doyle MG, Chugunova M, Roche SL, Keener JP. Lumped parameter models for two-ventricle and healthy and failing extracardiac Fontan circulations. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2021; 38:442-466. [PMID: 34534322 DOI: 10.1093/imammb/dqab012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022]
Abstract
Fontan circulations are surgical strategies to treat infants born with single ventricle physiology. Clinical and mathematical definitions of Fontan failure are lacking, and understanding is needed of parameters indicative of declining physiologies. Our objective is to develop lumped parameter models of two-ventricle and single-ventricle circulations. These models, their mathematical formulations and a proof of existence of periodic solutions are presented. Sensitivity analyses are performed to identify key parameters. Systemic venous and systolic left ventricular compliances and systemic capillary and pulmonary venous resistances are identified as key parameters. Our models serve as a framework to study the differences between two-ventricle and single-ventricle physiologies and healthy and failing Fontan circulations.
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Affiliation(s)
- Matthew G Doyle
- Department of Mechanical and Industrial Engineering and Division of Vascular Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marina Chugunova
- Institute of Mathematical Sciences, Claremont Graduate University, Claremont, CA 91711, USA
| | - S Lucy Roche
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON M5S 1A1, Canada
| | - James P Keener
- Department of Mathematics, University of Utah, Salt Lake City, UT 84112, USA
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8
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Farahmand M, Kavarana MN, Trusty PM, Kung EO. Target Flow-Pressure Operating Range for Designing a Failing Fontan Cavopulmonary Support Device. IEEE Trans Biomed Eng 2020; 67:2925-2933. [PMID: 32078526 DOI: 10.1109/tbme.2020.2974098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fontan operation as the current standard of care for the palliation of single ventricle defects results in significant late complications. Using a mechanical circulatory device for the right circulation to serve the function of the missing subpulmonary ventricle could potentially stabilize the failing Fontan circulation. This study aims to elucidate the hydraulic operating regions that should be targeted for designing cavopulmonary blood pumps. By integrating numerical analysis and available clinical information, the interaction of the cavopulmonary support via the IVC and full assist configurations with a wide range of simulated adult failing scenarios was investigated; with IVC and full assist corresponding to the inferior venous return or the entire venous return, respectively, being routed through the device. We identified the desired hydraulic operating regions for a cavopulmonary assist device by clustering all head pressures and corresponding pump flows that result in hemodynamic improvement for each simulated failing Fontan physiology. Results show that IVC support can produce beneficial hemodynamics in only a small fraction of failing Fontan scenarios. Cavopulmonary assist device could increase cardiac index by 35% and decrease the inferior vena cava pressure by 45% depending on the patient's pre-support hemodynamic state and surgical configuration of the cavopulmonary assist device (IVC or full support). The desired flow-pressure operating regions we identified can serve as the performance criteria for designing cavopulmonary assist devices as well as evaluating off-label use of commercially available left-side blood pumps for failing Fontan cavopulmonary support.
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Haranal M, Luo S, Honjo O. Mechanical Circulatory Support for Patients With Adult Congenital Heart Disease. Circ J 2020; 84:533-541. [DOI: 10.1253/circj.cj-19-0821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maruti Haranal
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children
| | - Shuhua Luo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children
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10
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Talwar S, Marathe SP, Choudhary SK, Airan B. Where are we after 50 years of the Fontan operation? Indian J Thorac Cardiovasc Surg 2020; 37:42-53. [PMID: 33584026 DOI: 10.1007/s12055-019-00906-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/02/2019] [Accepted: 11/08/2019] [Indexed: 01/11/2023] Open
Abstract
First introduced in 1971, the Fontan procedure is the final common destination for all patients with a functional single ventricle. The procedure itself has evolved tremendously over the last five decades. This review traces this journey and presents the importance, outcomes and future outlook of the procedure in the current era.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | | | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences Technology, Jaipur, India
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11
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Honjo O, Doyle MG, Amon CH. Commentary: Engineering an optimal mechanical circulatory support system for the cavopulmonary connection. J Thorac Cardiovasc Surg 2019; 159:e143-e144. [PMID: 31540736 DOI: 10.1016/j.jtcvs.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, Department of Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Matthew G Doyle
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cristina H Amon
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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12
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Crossland DS, Van De Bruaene A, Silversides CK, Hickey EJ, Roche SL. Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care. Can J Cardiol 2019; 35:1723-1739. [PMID: 31813505 DOI: 10.1016/j.cjca.2019.07.626] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022] Open
Abstract
There is mounting recognition that some of the most urgent problems of adult congenital heart disease (ACHD) are the prevention, diagnosis, and management of heart failure (HF). Recent expert consensus and position statements not only emphasize a specific and pressing need to tackle HF in ACHD (ACHD-HF) but also highlight the difficulty of doing so given a current sparsity of data. Some of the challenges will be addressed by this review. The authors are from 3 different centres; each centre has an established subspeciality ACHD-HF clinic and is able to provide heart transplant, multiorgan transplant, and mechanical support for patients with ACHD. Appropriate care of this complex population requires multidisciplinary ACHD-HF teams evaluate all possible treatment options. The risks and benefits of nontransplant ACHD surgery, percutaneous structural and electrophysiological intervention, and ongoing conservative management must be considered alongside those of transplant strategies. In our approach, advanced care planning and palliative care coexist with the consideration of advanced therapies. An ethos of shared decision making, guided by the patient's values and preferences, strengthens clinical care, but requires investment of time as well as skilled communication. In this review, we aim to offer practical real-world advice for managing these patients, supported by scientific data where it exists.
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Affiliation(s)
- David S Crossland
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom; Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Candice K Silversides
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edward J Hickey
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Lucy Roche
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Commentary: Mechanical support for the subpulmonary circulation of Fontan physiology-A step in the right direction. J Thorac Cardiovasc Surg 2019; 158:1436-1437. [PMID: 31255340 DOI: 10.1016/j.jtcvs.2019.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 11/22/2022]
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Hsia TY. Commentary: The Fontan paradox: A de Leval challenge. J Thorac Cardiovasc Surg 2019; 158:1434-1435. [PMID: 31128901 DOI: 10.1016/j.jtcvs.2019.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Tain-Yen Hsia
- Department of Pediatric Cardiac Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Conn.
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