1
|
Jalal Z, Langouet E, Dib N, Le-Quellenec S, Mostefa-Kara M, Martin A, Roubertie F, Thambo JB. Role and Applications of Experimental Animal Models of Fontan Circulation. J Clin Med 2024; 13:2601. [PMID: 38731130 PMCID: PMC11084605 DOI: 10.3390/jcm13092601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Over the last four decades, the Fontan operation has been the treatment of choice for children born with complex congenital heart diseases and a single-ventricle physiology. However, therapeutic options remain limited and despite ongoing improvements in initial surgical repair, patients still experience a multiplicity of cardiovascular complications. The causes for cardiovascular failure are multifactorial and include systemic ventricular dysfunction, pulmonary vascular resistance, atrioventricular valve regurgitation, arrhythmia, development of collaterals, protein-losing enteropathy, hepatic dysfunction, and plastic bronchitis, among others. The mechanisms leading to these late complications remain to be fully elucidated. Experimental animal models have been developed as preclinical steps that enable a better understanding of the underlying pathophysiology. They furthermore play a key role in the evaluation of the efficacy and safety of new medical devices prior to their use in human clinical studies. However, these experimental models have several limitations. In this review, we aim to provide an overview of the evolution and progress of the various types of experimental animal models used in the Fontan procedure published to date in the literature. A special focus is placed on experimental studies performed on animal models of the Fontan procedure with or without mechanical circulatory support as well as a description of their impact in the evolution of the Fontan design. We also highlight the contribution of animal models to our understanding of the pathophysiology and assess forthcoming developments that may improve the contribution of animal models for the testing of new therapeutic solutions.
Collapse
Affiliation(s)
- Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Pessac, France; (N.D.); (F.R.); (J.-B.T.)
- LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600 Pessac, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, 33600 Pessac, France
| | - Elise Langouet
- Department of Pediatric and Adult Congenital Cardiology Anesthesiology, University Hospital of Bordeaux, 33600 Pessac, France;
| | - Nabil Dib
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Pessac, France; (N.D.); (F.R.); (J.-B.T.)
- LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600 Pessac, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, 33600 Pessac, France
| | | | - Mansour Mostefa-Kara
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 75015 Paris, France;
| | - Amandine Martin
- Department of Cardiac Surgery, University Hospital, 97400 Saint-Denis, France;
| | - François Roubertie
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Pessac, France; (N.D.); (F.R.); (J.-B.T.)
- LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600 Pessac, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, 33600 Pessac, France
| | - Jean-Benoît Thambo
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Pessac, France; (N.D.); (F.R.); (J.-B.T.)
- LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600 Pessac, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, 33600 Pessac, France
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Sarfare S, Ali MS, Palazzolo A, Rodefeld M, Conover T, Figliola R, Giridharan G, Wampler R, Bennett E, Ivashchenko A. Computational Fluid Dynamics Turbulence Model and Experimental Study for a Fontan Cavopulmonary Assist Device. J Biomech Eng 2023; 145:111008. [PMID: 37535439 PMCID: PMC10777498 DOI: 10.1115/1.4063088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Head-flow HQ curves for a Fontan cavopulmonary assist device (CPAD) were measured using a blood surrogate in a mock circulatory loop and simulated with various computational fluid dynamics (CFD) models. The tests benchmarked the CFD tools for further enhancement of the CPAD design. Recommended Reynolds-Averaged Navier-Stokes (RANS) CFD approaches for the development of conventional ventricular assist devices (VAD) were found to have shortcomings when applied to the Fontan CPAD, which is designed to neutralize off-condition obstruction risks that could contribute to a major adverse event. The no-obstruction condition is achieved with a von Karman pump, utilizing large clearances and small blade heights, which challenge conventional VAD RANS-based CFD hemodynamic simulations. High-fidelity large eddy simulation (LES) is always recommended; however, this may be cost-inhibitive for optimization studies in commercial settings, thus the reliance on RANS models. This study compares head and power predictions of various RANS turbulence models, employing experimental measurements and LES results as a basis for comparison. The models include standard k-ϵ, re-normalization group k-ϵ, realizable k-ϵ, shear stress transport (SST) k-ω, SST with transitional turbulence, and Generalized k-ω. For the pressure head predictions, it was observed that the standard k-ϵ model provided far better agreement with experiment. For the rotor torque, k-ϵ predictions were 30% lower than LES, while the SST and LES torque values were near identical. For the Fontan CPAD, the findings support using LES for the final design simulations, k-ϵ model for head and general flow simulation, and SST for power, shear stress, hemolysis, and thrombogenicity predictions.
Collapse
Affiliation(s)
- Shreyas Sarfare
- Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843
| | - Md Shujan Ali
- Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843
| | - Alan Palazzolo
- Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843
| | - Mark Rodefeld
- Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Tim Conover
- Department of Mechanical & Bioengineering, Clemson University, Clemson, SC 29634
| | - Richard Figliola
- Department of Mechanical & Bioengineering, Clemson University, Clemson, SC 29634-0921
| | | | | | - Edward Bennett
- Mechanical Solutions, Inc., 11 Apollo Drive, Whippany, NJ 07981
| | | |
Collapse
|
5
|
Yang W, Conover TA, Figliola RS, Giridharan GA, Marsden AL, Rodefeld MD. Passive performance evaluation and validation of a viscous impeller pump for subpulmonary fontan circulatory support. Sci Rep 2023; 13:12668. [PMID: 37542111 PMCID: PMC10403595 DOI: 10.1038/s41598-023-38559-y] [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: 02/14/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
Patients with single ventricle defects undergoing the Fontan procedure eventually face Fontan failure. Long-term cavopulmonary assist devices using rotary pump technologies are currently being developed as a subpulmonary power source to prevent and treat Fontan failure. Low hydraulic resistance is a critical safety requirement in the event of pump failure (0 RPM) as a modest 2 mmHg cavopulmonary pressure drop can compromise patient hemodynamics. The goal of this study is therefore to assess the passive performance of a viscous impeller pump (VIP) we are developing for Fontan patients, and validate flow simulations against in-vitro data. Two different blade heights (1.09 mm vs 1.62 mm) and a blank housing model were tested using a mock circulatory loop (MCL) with cardiac output ranging from 3 to 11 L/min. Three-dimensional flow simulations were performed and compared against MCL data. In-silico and MCL results demonstrated a pressure drop of < 2 mmHg at a cardiac output of 7 L/min for both blade heights. There was good agreement between simulation and MCL results for pressure loss (mean difference - 0.23 mmHg 95% CI [0.24-0.71]). Compared to the blank housing model, low wall shear stress area and oscillatory shear index on the pump surface were low, and mean washout times were within 2 s. This study demonstrated the low resistance characteristic of current VIP designs in the failed condition that results in clinically acceptable minimal pressure loss without increased washout time as compared to a blank housing model under normal cardiac output in Fontan patients.
Collapse
Affiliation(s)
- Weiguang Yang
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA.
| | - Timothy A Conover
- Departments of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - Richard S Figliola
- Departments of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | | | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mark D Rodefeld
- Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
6
|
Li L, Wang J, Zhao G, Topaz S, Morales D, Yoganathan A, Ballard-Croft C, Zwischenberger JB, Wang D. Percutaneous Cavopulmonary Assist: From Design to 96 Hour Survival in Lethal Cavopulmonary Failure Sheep. ASAIO J 2023; 69:802-808. [PMID: 37084284 DOI: 10.1097/mat.0000000000001939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
We are developing a clinically practical percutaneous double lumen cannula (DLC)-based cavopulmonary assist (CPA) system to support failing Fontan patients. In this study, our CPA DLC was redesigned for even blood flow, minimal recirculation, and easy insertion/deployment. After bench testing, this new CPA system was evaluated for 4 hours (n = 10) and 96 hours (n = 5) in our clinically relevant lethal cavopulmonary failure (CPF) sheep model for ease of cannulation/deployment, reversal of CPF hemodynamics/end-organ hypoperfusion, and durability/biocompatibility. Cavopulmonary failure was achieved in all sheep. All DLCs were successfully inserted/deployed into Fontan anatomy. Cavopulmonary assist reversed CPF with normalized central venous pressure and cardiac output. All survival sheep were ambulatory with normal eating/drinking. One sheep was euthanized after 6 hours from cannula kinking, and one sheep died of hypokalemia after 8 hours. Three sheep survived 96 hours with normal hemodynamics. Free hemoglobin was only 3.7 ± 1.2 mg/dl at 96 hours, indicating negligible hemolysis. Creatinine, blood urea nitrogen, and lactate increased from hypoperfusion but normalized by 72 hours CPA. Necropsy showed only a small, immobilized thrombus ring at umbrella attachment to DLC. Our DLC-based system provided total ambulatory CPA in a lethal CPF sheep model with 96 hour survival and complete reversal of hemodynamics and end-organ hypoperfusion.
Collapse
Affiliation(s)
- Li Li
- From the Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Jingkun Wang
- From the Department of Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - David Morales
- Department of Pediatric Cardiovascular Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Ajit Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | | | - Dongfang Wang
- From the Department of Surgery, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Tobin N, Good BC, Plasencia JD, Fogel MA, Weiss WJ, Manning KB. Computational Investigation of Anastomosis Options of a Right-Heart Pump to Patient Specific Pulmonary Arteries. Ann Biomed Eng 2022; 50:929-940. [PMID: 35451680 DOI: 10.1007/s10439-022-02969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
Patients with Fontan circulation have increased risk of heart failure, but are not always candidates for heart transplant, leading to the development of the subpulmonic Penn State Fontan Circulation Assist Device. The aim of this study was to use patient-specific computational fluid dynamics simulations to evaluate anastomosis options for implanting this device. Simulations were performed of the pre-surgical anatomy as well as four surgical options: a T-junction and three Y-grafts. Cases were evaluated based on several fluid-dynamic quantities. The impact of imbalanced left-right pulmonary flow distribution was also investigated. Results showed that a 12-mm Y-graft was the most energy efficient. However, an 8-mm graft showed more favorable wall shear stress distribution, indicating lower risk of thrombosis and endothelial damage. The 8-mm Y-grafts also showed a more balanced pulmonary flow split, and lower residence time, also indicating lower thrombosis risk. The relative performance of the surgical options was largely unchanged whether or not the pulmonary vascular resistance remained imbalanced post-implantation.
Collapse
Affiliation(s)
- Nicolas Tobin
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Bryan C Good
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | | | - Mark A Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - William J Weiss
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA.
| |
Collapse
|
9
|
Ponnaluri S, Christensen E, Good B, Kubicki C, Deutsch S, Cysyk J, Weiss WJ, Manning KB. Experimental Hemodynamics within the Penn State Fontan Circulatory Assist Device. J Biomech Eng 2021; 144:1129243. [PMID: 34897373 DOI: 10.1115/1.4053210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Indexed: 11/08/2022]
Abstract
For children born with a single functional ventricle, the Fontan operation bypasses the right ventricle by forming a four-way total cavopulmonary connection adapting the existing ventricle for the systemic circulation. However, upon adulthood, many Fontan patients exhibit low cardiac output and elevated venous pressure, eventually requiring a heart transplantation. Despite efforts to develop a Fontan pump or use an existing ventricular assist device for failing Fontan support, there is still no device designed or tested for subpulmonary support. Penn State University is developing a hydrodynamically levitated Fontan circulatory assist device (FCAD) for bridge-to-transplant or destination therapy. The FCAD hemodynamics, at both steady and pulsatile conditions for three pump operating conditions, were quantified using particle image velocimetry to determine the velocity magnitudes and Reynolds normal and shear stresses. Data were acquired at three planes (0 mm and ±25% of the radius) for the inferior and superior vena cavae inlets and the pulmonary artery outlet. The inlets had a blunt velocity profile that became skewed towards the collecting volute as fluid approached the rotor. At the outlet, regardless of the flow condition, a high-velocity jet exited the volute and moved downstream in a helical pattern. Turbulent stresses observed at the volute exit were influenced by the rotor's rotation. Regardless of inlet conditions, the pump demonstrated advantageous behavior for clinical use with a predictable flow field and a low risk of platelet adhesion and hemolysis based on calculated wall shear rates and turbulent stresses, respectively.
Collapse
Affiliation(s)
- Sailahari Ponnaluri
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Emma Christensen
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Bryan Good
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Cody Kubicki
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Steven Deutsch
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Joshua Cysyk
- Department of Surgery, Penn State Hershey Medical Center, PA; H151 Surgery Hershey PA 17033, The Milton S. Hershey Medical Center
| | - William J Weiss
- Department of Surgery, Penn State Hershey Medical Center, PA; H151 Surgery Hershey PA 17033, The Milton S. Hershey Medical Center
| | - Keefe B Manning
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, Department of Surgery, Penn State Hershey Medical Center, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| |
Collapse
|
10
|
Wang Y, Peng J, Qin K, Rodefeld MD, Luan Y, Giridharan GA. Control strategy to enhance pulmonary vascular pulsatility for implantable cavopulmonary assist devices: A simulation study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.103008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
11
|
Comparison between Single-Phase Flow Simulation and Multiphase Flow Simulation of Patient-Specific Total Cavopulmonary Connection Structures Assisted by a Rotationally Symmetric Blood Pump. Symmetry (Basel) 2021. [DOI: 10.3390/sym13050912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To accurately assess the hemolysis risk of the ventricular assist device, this paper proposed a cell destruction model and the corresponding evaluation parameters based on multiphase flow. The single-phase flow and multiphase flow in two patient-specific total cavopulmonary connection structures assisted by a rotationally symmetric blood pump (pump-TCPC) were simulated. Then, single-phase and multiphase cell destruction models were used to evaluate the hemolysis risk. The results of both cell destruction models indicated that the hemolysis risk in the straight pump-TCPC model was lower than that in the curved pump-TCPC model. However, the average and maximum values of the multiphase flow blood damage index (mBDI) were smaller than those of the single-phase flow blood damage index (BDI), but the average and maximum values of the multiphase flow particle residence time (mPRT) were larger than those of the single-phase flow particle residence time (PRT). This study proved that the multiphase flow method can be used to simulate the mechanical behavior of red blood cells (RBCs) and white blood cells (WBCs) in a complex flow field and the multiphase flow cell destruction model had smaller estimates of the impact shear stress.
Collapse
|
12
|
Wang Y, Peng J, Rodefeld MD, Luan Y, Giridharan GA. A sensorless physiologic control strategy for continuous flow cavopulmonary circulatory support devices. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Trusty PM, Tree M, Maher K, Slesnick TC, Kanter KR, Yoganathan AP, Deshpande SR. An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support. J Thorac Cardiovasc Surg 2019; 158:1413-1421. [DOI: 10.1016/j.jtcvs.2019.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/22/2019] [Accepted: 04/12/2019] [Indexed: 11/16/2022]
|
15
|
Broda CR, Adachi I. Commentary: Fontan assist device support: Road map to "stage 4" palliation. J Thorac Cardiovasc Surg 2019; 158:1422-1423. [PMID: 31493880 DOI: 10.1016/j.jtcvs.2019.06.101] [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: 06/17/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Christopher R Broda
- Department of Pediatrics, Pediatric and Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | - Iki Adachi
- Department of Surgery, Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex.
| |
Collapse
|
16
|
Rodefeld MD, Marsden A, Figliola R, Jonas T, Neary M, Giridharan GA. Cavopulmonary assist: Long-term reversal of the Fontan paradox. J Thorac Cardiovasc Surg 2019; 158:1627-1636. [PMID: 31564543 DOI: 10.1016/j.jtcvs.2019.06.112] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Fontan circulatory inefficiency can be addressed by replacing the missing subpulmonary power source to reverse the Fontan paradox. An implantable cavopulmonary assist device is described that will simultaneously reduce systemic venous pressure and increase pulmonary arterial pressure, improving preload and cardiac output, in a univentricular Fontan circulation on a long-term basis. METHODS A rotary blood pump that was based on the von Karman viscous pump was designed for implantation into the total cavopulmonary connection (TCPC). It will impart modest pressure energy to augment Fontan flow without risk of obstruction. In the event of rotational failure, it is designed to default to a passive flow diverter. Pressure-flow performance was characterized in vitro in a Fontan mock circulatory loop with blood analog. RESULTS The pump performed through the fully specified operating range, augmenting flow in all 4 directions of the TCPC. Pressure rise of 6 to 8 mm Hg was readily achieved, ranging to 14 mm Hg at highest speed (5600 rpm). Performance was consistent across a wide range of cardiac outputs. In stalled condition (0 rpm), there was no discernible pressure loss across the TCPC. CONCLUSIONS A blood pump technology is described that can reverse the Fontan paradox and may permit a surgical strategy of long-term biventricular maintenance of a univentricular Fontan circulation. The technology is intended for Fontan failure in which right-sided circulatory inefficiencies predominate and ventricular systolic function is preserved. It may also apply before clinical Fontan failure as health maintenance to preempt the progression of Fontan disease.
Collapse
Affiliation(s)
- Mark D Rodefeld
- Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine and James Whitcomb Riley Hospital for Children, Indianapolis, Ind.
| | - Alison Marsden
- Department of Bioengineering and Pediatrics, Stanford University, Stanford, Calif
| | - Richard Figliola
- Department of Mechanical Engineering, Clemson University, Clemson, SC
| | | | - Michael Neary
- Rotor Bearing Technology and Software Inc, Phoenixville, Pa
| | | |
Collapse
|
17
|
Van Puyvelde J, Rega F, Minami T, Claus P, Cools B, Gewillig M, Meyns B. Creation of the Fontan circulation in sheep: a survival model. Interact Cardiovasc Thorac Surg 2019; 29:15-21. [DOI: 10.1093/icvts/ivz022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/30/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joeri Van Puyvelde
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tomoyuki Minami
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
18
|
Dual-Propeller Cavopulmonary Pump for Assisting Patients with Hypoplastic Right Ventricle. ASAIO J 2019; 65:888-897. [PMID: 30688694 DOI: 10.1097/mat.0000000000000907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Various congenital heart defects (CHDs) are characterized by the existence of a single functional ventricle, which perfuses both the systemic and pulmonary circulation. A three-stage palliation procedure, including the final Fontan completion, is often adopted by surgeons to treat patients with such CHDs. The completion Fontan involves the creation of a total cavopulmonary connection (TCPC), commonly accomplished with an extracardiac conduit. This TCPC results in nonphysiologic flow conditions that can lead to systemic venous hypertension, reduced cardiac output, and ultimately the need for heart transplantation. A modest pressure rise of 5-6 mm Hg could correct the abnormal flow dynamics in these patients. To achieve this, we propose a novel conceptual design of a dual-propeller pump inside a flared TCPC. The TCPC dual-propeller conjunction was examined for hydraulic performance, blood flow pattern, and potential for hemolysis inside the TCPC using computational fluid dynamics (CFD). The effect of axial distance between the two propellers on the blood flow interference and energy loss was studied to determine the optimal separation distance. Both the inferior vena cava (IVC) and superior vena cava (SVC) propellers provided a pressure rise of 1-20 mm Hg at flow rates ranging from 0.4 to 7 lpm while rotating at speeds of 6,000-12,000 rpm. Larger separation distance provided favorable performance in terms of flow interference, energy loss, and blood damage potential. The ability of a dual-propeller micropump to provide the required pressure rise would help to augment the cavopulmonary flow and mimic flows seen in normal biventricular circulation.
Collapse
|
19
|
Granegger M, Valencia A, Quandt D, Dave H, Kretschmar O, Hübler M, Schweiger M. Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review. World J Pediatr Congenit Heart Surg 2019; 10:81-89. [DOI: 10.1177/2150135118802788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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 full-text 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.
Collapse
Affiliation(s)
- Marcus Granegger
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Anna Valencia
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Daniel Quandt
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Michael Hübler
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Martin Schweiger
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
Trusty PM, Tree M, Vincent D, Naber JP, Maher K, Yoganathan AP, Deshpande SR. In Vitro Examination of the VentriFlo True Pulse Pump for Failing Fontan Support. Artif Organs 2018; 43:181-188. [DOI: 10.1111/aor.13301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Phillip M. Trusty
- Wallace H. Coulter Department of Biomedical Engineering Atlanta GA USA
| | - Mike Tree
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology Atlanta GA USA
| | | | | | - Kevin Maher
- Department of Pediatrics, Pediatric Cardiology Division Emory University School of Medicine Atlanta GA USA
| | | | - Shriprasad R. Deshpande
- Department of Pediatrics, Pediatric Cardiology Division Emory University School of Medicine Atlanta GA USA
| |
Collapse
|
21
|
Sinha L, Yerebakan C. The first integrated aortic turbine venous-assist system is born. J Thorac Cardiovasc Surg 2018; 156:304-305. [PMID: 29753509 DOI: 10.1016/j.jtcvs.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Lok Sinha
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Can Yerebakan
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| |
Collapse
|
22
|
Broda CR, Taylor DA, Adachi I. Progress in experimental and clinical subpulmonary assistance for Fontan circulation. J Thorac Cardiovasc Surg 2018; 156:1949-1956. [PMID: 29884497 DOI: 10.1016/j.jtcvs.2018.04.102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Christopher R Broda
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
| | - Doris A Taylor
- Regenerative Medicine Research, Texas Heart Institute, Houston, Tex
| | - Iki Adachi
- Department of Congenital Heart Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
| |
Collapse
|
23
|
Pekkan K, Aka IB, Tutsak E, Ermek E, Balim H, Lazoglu I, Turkoz R. In vitro validation of a self-driving aortic-turbine venous-assist device for Fontan patients. J Thorac Cardiovasc Surg 2018; 156:292-301.e7. [PMID: 29666009 PMCID: PMC6021195 DOI: 10.1016/j.jtcvs.2018.02.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/11/2018] [Accepted: 02/08/2018] [Indexed: 11/30/2022]
Abstract
Background Palliative repair of single ventricle defects involve a series of open-heart surgeries where a single-ventricle (Fontan) circulation is established. As the patient ages, this paradoxical circulation gradually fails, because of its high venous pressure levels. Reversal of the Fontan paradox requires an extra subpulmonic energy that can be provided through mechanical assist devices. The objective of this study was to evaluate the hemodynamic performance of a totally implantable integrated aortic-turbine venous-assist (iATVA) system, which does not need an external drive power and maintains low venous pressure chronically, for the Fontan circulation. Methods Blade designs of the co-rotating turbine and pump impellers were developed and 3 prototypes were manufactured. After verifying the single-ventricle physiology at a pulsatile in vitro circuit, the hemodynamic performance of the iATVA system was measured for pediatric and adult physiology, varying the aortic steal percentage and circuit configurations. The iATVA system was also tested at clinical off-design scenarios. Results The prototype iATVA devices operate at approximately 800 revolutions per minute and extract up to 10% systemic blood from the aorta to use this hydrodynamic energy to drive a blood turbine, which in turn drives a mixed-flow venous pump passively. By transferring part of the available energy from the single-ventricle outlet to the venous side, the iATVA system is able to generate up to approximately 5 mm Hg venous recovery while supplying the entire caval flow. Conclusions Our experiments show that a totally implantable iATVA system is feasible, which will eliminate the need for external power for Fontan mechanical venous assist and combat gradual postoperative venous remodeling and Fontan failure.
Collapse
Affiliation(s)
- Kerem Pekkan
- Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey.
| | - Ibrahim Basar Aka
- Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
| | - Ece Tutsak
- Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
| | - Erhan Ermek
- Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
| | - Haldun Balim
- Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
| | - Ismail Lazoglu
- Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
| | - Riza Turkoz
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem University, Istanbul, Turkey
| |
Collapse
|
24
|
Throckmorton A, Kapadia J, Madduri D. Mechanical axial flow blood pump to support cavopulmonary circulation. Int J Artif Organs 2018; 31:970-82. [DOI: 10.1177/039139880803101107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We are developing a collapsible, percutaneously inserted, axial flow blood pump to support the cavopulmonary circulation in infants with a failing single ventricle physiology. An initial design of the impeller for this axial flow blood pump was performed using computational fluid dynamics analysis, including pressure-flow characteristics, scalar stress estimations, blood damage indices, and fluid force predictions. A plastic prototype was constructed for hydraulic performance testing, and these experimental results were compared with the numerical predictions. The numerical predictions and experimental findings of the pump performance demonstrated a pressure generation of 2–16 mm Hg for 50–750 ml/min over 5,500–7,500 RPM with deviation found at lower rotational speeds. The axial fluid forces remained below 0.1 N, and the radial fluid forces were determined to be virtually zero due to the centered impeller case. The scalar stress levels remained below 250 Pa for all operating conditions. Blood damage analysis yielded a mean residence time of the released particles, which was found to be less than 0.4 seconds for both flow rates that were examined, and a maximum residence time was determined to be less than 0.8 seconds. We are in the process of designing a cage with hydrodynamically shaped filament blades to act as a diffuser and optimizing the impeller blade shape to reduce the flow vorticity at the pump outlet. This blood pump will improve the clinical treatment of patients with failing Fontan physiology and provide a unique catheter-based therapeutic approach as a bridge to recovery or transplantation.
Collapse
Affiliation(s)
- A.L. Throckmorton
- Department of Mechanical Engineering, Virginia Commonwealth University, Richmond, Virginia - USA
| | - J. Kapadia
- Department of Mechanical Engineering, Virginia Commonwealth University, Richmond, Virginia - USA
| | - D. Madduri
- Department of Mechanical Engineering, Virginia Commonwealth University, Richmond, Virginia - USA
| |
Collapse
|
25
|
Bruse JL, Giusti G, Baker C, Cervi E, Hsia TY, Taylor AM, Schievano S. Statistical Shape Modeling for Cavopulmonary Assist Device Development: Variability of Vascular Graft Geometry and Implications for Hemodynamics. J Med Device 2017; 11. [PMID: 28479938 DOI: 10.1115/1.4035865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients born with a single functional ventricle typically undergo three-staged surgical palliation in the first years of life, with the last stage realizing a cross-like total cavopulmonary connection (TCPC) of superior and inferior vena cavas (SVC and IVC) with both left and right pulmonary arteries, allowing all deoxygenated blood to flow passively back to the lungs (Fontan circulation). Even though within the past decades more patients survive into adulthood, the connection comes at the prize of deficiencies such as chronic systemic venous hypertension and low cardiac output, which ultimately may lead to Fontan failure. Many studies have suggested that the TCPC's inherent insufficiencies might be addressed by adding a cavopulmonary assist device (CPAD) to provide the necessary pressure boost. While many device concepts are being explored, few take into account the complex cardiac anatomy typically associated with TCPCs. In this study, we focus on the extra cardiac conduit vascular graft connecting IVC and pulmonary arteries as one possible landing zone for a CPAD and describe its geometric variability in a cohort of 18 patients that had their TCPC realized with a 20mm vascular graft. We report traditional morphometric parameters and apply statistical shape modeling to determine the main contributors of graft shape variability. Such information may prove useful when designing CPADs that are adapted to the challenging anatomical boundaries in Fontan patients. We further compute the anatomical mean 3D graft shape (template graft) as a representative of key shape features of our cohort and prove this template graft to be a significantly better approximation of population and individual patient's hemodynamics than a commonly used simplified tube geometry. We therefore conclude that statistical shape modeling results can provide better models of geometric and hemodynamic boundary conditions associated with complex cardiac anatomy, which in turn may impact on improved cardiac device development.
Collapse
Affiliation(s)
- Jan L Bruse
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Giuliano Giusti
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Catriona Baker
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Elena Cervi
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Tain-Yen Hsia
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | | |
Collapse
|
26
|
Morray BH, Dimas VV, Lim S, Balzer DT, Parekh DR, Van Mieghem NM, Ewert P, Kim DW, Justino H, McElhinney DB, Jones TK. Circulatory support using the impella device in fontan patients with systemic ventricular dysfunction: A multicenter experience. Catheter Cardiovasc Interv 2017; 90:118-123. [DOI: 10.1002/ccd.26885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/12/2016] [Accepted: 11/20/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Brian H. Morray
- Division of Cardiology; Seattle Children's Hospital; Seattle Washington
| | - Vivian V. Dimas
- Division of Cardiology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Scott Lim
- Division of Pediatric Cardiology; University of Virginia; Charlottesville Virginia
| | - David T. Balzer
- Division of Pediatric Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Dhaval R. Parekh
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Nicolas M. Van Mieghem
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease; Deutsches Herzzentrum München; München Germany
| | - Dennis W. Kim
- Division of Pediatric Cardiology; Children's Healthcare of Atlanta, Emory University; Atlanta Georgia
| | - Henri Justino
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Doff B. McElhinney
- Department of Cardiothoracic Surgery; Lucille Packard Children's Hospital at Stanford; Palo Alto California
| | - Thomas K. Jones
- Division of Cardiology; Seattle Children's Hospital; Seattle Washington
| |
Collapse
|
27
|
Vaughn G, Moore J, Lamberti J, Canter C. Management of the failing Fontan: Medical, interventional and surgical treatment. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
Biermann D, Eder A, Arndt F, Seoudy H, Reichenspurner H, Mir T, Riso A, Kozlik-Feldmann R, Peldschus K, Kaul MG, Schuler T, Krasemann S, Hansen A, Eschenhagen T, Sachweh JS. Towards a Tissue-Engineered Contractile Fontan-Conduit: The Fate of Cardiac Myocytes in the Subpulmonary Circulation. PLoS One 2016; 11:e0166963. [PMID: 27875570 PMCID: PMC5119816 DOI: 10.1371/journal.pone.0166963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022] Open
Abstract
The long-term outcome of patients with single ventricles improved over time, but remains poor compared to other congenital heart lesions with biventricular circulation. Main cause for this unfavourable outcome is the unphysiological hemodynamic of the Fontan circulation, such as subnormal systemic cardiac output and increased systemic-venous pressure. To overcome this limitation, we are developing the concept of a contractile extracardiac Fontan-tunnel. In this study, we evaluated the survival and structural development of a tissue-engineered conduit under in vivo conditions. Engineered heart tissue was generated from ventricular heart cells of neonatal Wistar rats, fibrinogen and thrombin. Engineered heart tissues started beating around day 8 in vitro and remained contractile in vivo throughout the experiment. After culture for 14 days constructs were implanted around the right superior vena cava of Wistar rats (n = 12). Animals were euthanized after 7, 14, 28 and 56 days postoperatively. Hematoxylin and eosin staining showed cardiomyocytes arranged in thick bundles within the engineered heart tissue-conduit. Immunostaining of sarcomeric actin, alpha-actin and connexin 43 revealed a well -developed cardiac myocyte structure. Magnetic resonance imaging (d14, n = 3) revealed no constriction or stenosis of the superior vena cava by the constructs. Engineered heart tissues survive and contract for extended periods after implantation around the superior vena cava of rats. Generation of larger constructs is warranted to evaluate functional benefits of a contractile Fontan-conduit.
Collapse
Affiliation(s)
- Daniel Biermann
- Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Alexandra Eder
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Florian Arndt
- Department for Paediatric Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hatim Seoudy
- Department for Cardiovascular Surgery, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department for Cardiovascular Surgery, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Mir
- Department for Paediatric Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arlindo Riso
- Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department for Paediatric Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kersten Peldschus
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G. Kaul
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tillman Schuler
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Hansen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Eschenhagen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jörg S. Sachweh
- Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
29
|
Shimizu S, Kawada T, Une D, Fukumitsu M, Turner MJ, Kamiya A, Shishido T, Sugimachi M. Partial cavopulmonary assist from the inferior vena cava to the pulmonary artery improves hemodynamics in failing Fontan circulation: a theoretical analysis. J Physiol Sci 2016; 66:249-55. [PMID: 26546008 PMCID: PMC10717700 DOI: 10.1007/s12576-015-0422-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022]
Abstract
Cavopulmonary assist (CPA) for failing Fontan patients remains a challenging issue in the clinical setting. To evaluate the effectiveness of a partial CPA from the inferior vena cava (IVC) to the pulmonary artery (PA), we performed a theoretical analysis using a computational model of the Fontan circulation. Cardiac chambers and vascular systems were described as the time-varying elastance model and the modified three-element Windkessel model, respectively. A rotational pump described as a non-linear function was inserted between the IVC and the PA. When pulmonary vascular resistance index varied from 2.1 to 5.9 Wood units m(2), the partial CPA maintained cardiac index as efficiently as total CPA and markedly reduced the IVC pressure compared with total CPA. However, the partial CPA increased the superior vena cava pressure substantially. The modification from total to partial CPA is potentially an effective alternative in failing Fontan patients suffering from high IVC pressure.
Collapse
Affiliation(s)
- Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Dai Une
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Michael James Turner
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Atsunori Kamiya
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Toshiaki Shishido
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| |
Collapse
|
30
|
Budts W, Roos-Hesselink J, Rädle-Hurst T, Eicken A, McDonagh TA, Lambrinou E, Crespo-Leiro MG, Walker F, Frogoudaki AA. Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2016; 37:1419-27. [PMID: 26787434 DOI: 10.1093/eurheartj/ehv741] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | | | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences Cyprus University of Technology, Limassol, Cyprus
| | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Service, Hospital Universitario A Coruña, La Coruña, Spain
| | - Fiona Walker
- Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Alexandra A Frogoudaki
- Adult Congenital Heart Clinic, Second Cardiology Department, ATTIKON University Hospital and Athens University, Athens, Greece
| |
Collapse
|
31
|
Gandolfo F, Brancaccio G, Donatiello S, Filippelli S, Perri G, Iannace E, D'Amario D, Testa G, D'Avenio G, Grigioni M, Amodeo A. Mechanically Assisted Total Cavopulmonary Connection With an Axial Flow Pump: Computational and In Vivo Study. Artif Organs 2015; 40:43-9. [DOI: 10.1111/aor.12641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Fabrizio Gandolfo
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Gianluca Brancaccio
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Salvatore Donatiello
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
- Department of Technology and Health; Italian National Institute of Health; Rome Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Gianluigi Perri
- Department of Cardiology; Policlinico A. Gemelli; Rome Italy
| | - Enrico Iannace
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | | | - Giuseppina Testa
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Giuseppe D'Avenio
- Department of Technology and Health; Italian National Institute of Health; Rome Italy
| | - Mauro Grigioni
- Department of Technology and Health; Italian National Institute of Health; Rome Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| |
Collapse
|
32
|
Hsia TY, Figliola R. Multiscale modelling of single-ventricle hearts for clinical decision support: a Leducq Transatlantic Network of Excellence. Eur J Cardiothorac Surg 2015; 49:365-8. [PMID: 26489838 DOI: 10.1093/ejcts/ezv368] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tain-Yen Hsia
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Figliola
- Department of Mechanical and Bioengineering, Clemson University, Clemson, NC, USA
| | | | | |
Collapse
|
33
|
Cavopulmonary assist for the failing Fontan circulation: impact of ventricular function on mechanical support strategy. ASAIO J 2015; 60:707-15. [PMID: 25158887 DOI: 10.1097/mat.0000000000000135] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mechanical circulatory support--either ventricular assist device (VAD, left-sided systemic support) or cavopulmonary assist device (CPAD, right-sided support)--has been suggested as treatment for Fontan failure. The selection of left- versus right-sided support for failing Fontan has not been previously defined. Computer simulation and mock circulation models of pediatric Fontan patients (15-25 kg) with diastolic, systolic, and combined systolic and diastolic dysfunction were developed. The global circulatory response to assisted Fontan flow using VAD (HeartWare HVAD, Miami Lakes, FL) support, CPAD (Viscous Impeller Pump, Indianapolis, IN) support, and combined VAD and CPAD support was evaluated. Cavopulmonary assist improves failing Fontan circulation during diastolic dysfunction but preserved systolic function. In the presence of systolic dysfunction and elevated ventricular end-diastolic pressure (VEDP), VAD support augments cardiac output and diminishes VEDP, while increased preload with cavopulmonary assist may worsen circulatory status. Fontan circulation can be stabilized to biventricular values with modest cavopulmonary assist during diastolic dysfunction. Systemic VAD support may be preferable to maintain systemic output during systolic dysfunction. Both systemic and cavopulmonary support may provide best outcome during combined systolic and diastolic dysfunction. These findings may be useful to guide clinical cavopulmonary assist strategies in failing Fontan circulations.
Collapse
|
34
|
Mechanical Circulatory Support of a Univentricular Fontan Circulation with a Continuous Axial-Flow Pump in a Piglet Model. ASAIO J 2015; 61:196-201. [DOI: 10.1097/mat.0000000000000172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
35
|
|
36
|
Kowalski WJ, Teslovich NC, Menon PG, Tinney JP, Keller BB, Pekkan K. Left atrial ligation alters intracardiac flow patterns and the biomechanical landscape in the chick embryo. Dev Dyn 2014; 243:652-62. [PMID: 24868595 DOI: 10.1002/dvdy.24107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypoplastic left heart syndrome (HLHS) is a major human congenital heart defect that results in single ventricle physiology and high mortality. Clinical data indicate that intracardiac blood flow patterns during cardiac morphogenesis are a significant etiology. We used the left atrial ligation (LAL) model in the chick embryo to test the hypothesis that LAL immediately alters intracardiac flow streams and the biomechanical environment, preceding morphologic and structural defects observed in HLHS. RESULTS Using fluorescent dye injections, we found that intracardiac flow patterns from the right common cardinal vein, right vitelline vein, and left vitelline vein were altered immediately following LAL. Furthermore, we quantified a significant ventral shift of the right common cardinal and right vitelline vein flow streams. We developed an in silico model of LAL, which revealed that wall shear stress was reduced at the left atrioventricular canal and left side of the common ventricle. CONCLUSIONS Our results demonstrate that intracardiac flow patterns change immediately following LAL, supporting the role of hemodynamics in the progression of HLHS. Sites of reduced WSS revealed by computational modeling are commonly affected in HLHS, suggesting that changes in the biomechanical environment may lead to abnormal growth and remodeling of left heart structures.
Collapse
|
37
|
Abstract
Our goal was to develop a less invasive total cavopulmonary connection (TCPC) sheep model for testing total cavopulmonary assist (CPA) devices. Thirteen sheep underwent a right fourth intercostal lateral thoracotomy. In series I (n = 6), a polytetrafluoroethylene (PTFE) extracardiac conduit (ECC) was connected to inferior vena cava (IVC) and superior vena cava (SVC) by end-to-side anastomosis. The SVC/IVC remained connected to right atrium (RA). A PTFE graft bridged ECC to right pulmonary artery (RPA). Clamps between SVC/IVC anastomoses and RA diverted total venous blood to pulmonary circulation. In series II (n = 7), temporary bypasses between SVC/IVC and RA allowed SVC/IVC to be cut off from RA for better RPA exposure. The ECC-SVC/IVC were end-end anastomosed and ECC-RPA side-side anastomosed for total SVC/IVC to pulmonary artery (PA) conversion. In each series, one sheep died of bleeding. In five sheep in series I and six sheep in series II, the TCPC model was successfully created with significantly increased central venous pressure and significantly decreased PA pressure/arterial blood pressure. Our acute TCPC sheep model has a less traumatic right thoracotomy with no cardiopulmonary bypass and less blood loss with no blood transfusion, facilitating future long-term CPA device evaluation.
Collapse
|
38
|
Derk G, Laks H, Biniwale R, Patel S, De LaCruz K, Mazor E, Williams R, Valdovinos J, Levi DS, Reardon L, Aboulhosn J. Novel techniques of mechanical circulatory support for the right heart and Fontan circulation. Int J Cardiol 2014; 176:828-32. [DOI: 10.1016/j.ijcard.2014.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/02/2014] [Indexed: 11/16/2022]
|
39
|
A paired membrane umbrella double-lumen cannula ensures consistent cavopulmonary assistance in a Fontan sheep model. J Thorac Cardiovasc Surg 2014; 148:1041-7; discussion 1047. [PMID: 24930609 DOI: 10.1016/j.jtcvs.2014.04.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The Avalon Elite (Macquet, Rastatt, Germany) double-lumen cannula can provide effective cavopulmonary assistance in a Fontan (total cavopulmonary connection) sheep model, but it requires strict alignment. The objective was to fabricate and test a newly designed paired umbrella double-lumen cannula without alignment requirement. METHODS The paired membrane umbrellas were designed on the double-lumen cannula to bracket infusion blood flow toward the pulmonary artery. Two umbrellas were attached, one 4 cm above and one 4 cm below the infusion opening. Umbrellas were temporarily wrapped and glued to the double-lumen cannula body to facilitate insertion. A total cavopulmonary connection mock loop was used to test cavopulmonary assistance performance and reliability with double-lumen cannula rotation and displacement. The paired umbrella double-lumen cannula also was tested in a total cavopulmonary connection adult sheep model (n = 6). RESULTS The bench test showed up to 4.5 L/min pumping flow and approximately 90% pumping flow efficiency at 360° rotation and 8-cm displacement of double-lumen cannula. The total cavopulmonary connection model with compromised hemodynamics was successfully created in all 6 sheep. The cavopulmonary assistance double-lumen cannula with paired umbrellas was smoothly inserted into the superior vena cava and extracardiac conduit in all sheep. At 3.5 to 4.0 L/min pump flow, the systolic arterial blood pressure and central venous pressure returned to normal baseline and remained stable throughout the 90-minute experiment, demonstrating effective cavopulmonary assistance support. Double-lumen cannula rotation and displacement did not affect performance. Autopsy revealed well-opened and positioned paired umbrellas, and double-lumen cannulas were easily removed from the right jugular vein. CONCLUSIONS Our double-lumen cannula with paired umbrellas is easy to insert and remove. The paired umbrellas eliminated the strict alignment requirement and ensured consistent cavopulmonary assistance performance.
Collapse
|
40
|
Affiliation(s)
- Christina J. VanderPluym
- From the Department of Cardiology, Children’s Hospital Boston, Boston, MA (C.J.V., E.D.B.); and Department of Cardiac Surgery, Children’s Hospital Boston and the Department of Pediatrics and Surgery, Harvard Medical School, Boston, MA (F.F.-T.)
| | - Francis Fynn-Thompson
- From the Department of Cardiology, Children’s Hospital Boston, Boston, MA (C.J.V., E.D.B.); and Department of Cardiac Surgery, Children’s Hospital Boston and the Department of Pediatrics and Surgery, Harvard Medical School, Boston, MA (F.F.-T.)
| | - Elizabeth D. Blume
- From the Department of Cardiology, Children’s Hospital Boston, Boston, MA (C.J.V., E.D.B.); and Department of Cardiac Surgery, Children’s Hospital Boston and the Department of Pediatrics and Surgery, Harvard Medical School, Boston, MA (F.F.-T.)
| |
Collapse
|
41
|
Lebel V, Alderson M, Aita M. Physiological stability: a concept analysis. J Adv Nurs 2014; 70:1995-2004. [DOI: 10.1111/jan.12391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Valerie Lebel
- Faculty of Nursing; University of Montreal; Quebec Canada
| | - Marie Alderson
- Faculty of Nursing; University of Montreal; Quebec Canada
| | - Marilyn Aita
- Faculty of Nursing; University of Montreal; Quebec Canada
| |
Collapse
|
42
|
Valdovinos J, Shkolyar E, Carman GP, Levi DS. In Vitro Evaluation of an External Compression Device for Fontan Mechanical Assistance. Artif Organs 2013; 38:199-207. [DOI: 10.1111/aor.12152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- John Valdovinos
- Biomedical Engineering Interdepartmental Program; UCLA; Los Angeles CA USA
| | | | - Gregory P. Carman
- Mechanical and Aerospace Engineering Department; UCLA; Los Angeles CA USA
| | - Daniel S. Levi
- Mattel Children's Hospital at UCLA; UCLA; Los Angeles CA USA
| |
Collapse
|
43
|
Gelow JM, Song HK, Weiss JB, Mudd JO, Broberg CS. Organ allocation in adults with congenital heart disease listed for heart transplant: impact of ventricular assist devices. J Heart Lung Transplant 2013; 32:1059-64. [PMID: 23921356 DOI: 10.1016/j.healun.2013.06.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Adults with congenital heart disease (CHD) listed for heart transplantation are rarely supported by ventricular assist devices (VADs). This may be a disadvantage to their priority for organ allocation. We sought to determine the relationship between VAD implantation and successful transplantation among patients listed for heart transplant. METHODS Adults with CHD patients (N = 1,250) were identified from the United Network for Organ Sharing (UNOS) database from 1985 to 2010 and compared to patients without congenital etiology for heart failure (N = 59,606). VAD use at listing, listing status, status upgrades and reasons for upgrade prior to transplant were trended at 5-year intervals and appropriate statistical comparisons were made between groups. RESULTS Since 1985, VAD use prior to transplant has increased significantly in patients without CHD, but not in CHD patients (17% vs 3% in 2006 to 2010, p < 0.0001). CHD patients were more likely to be listed as Status 2, compared to those without (66% vs 40%, p < 0.001 for 2006 to 2010), and less likely to be upgraded to Status 1 after listing (43% vs 55%, p = 0.03). Among those upgraded to Status 1, CHD patients were less likely to have a VAD at transplant than those without (3% vs 18%, p = 0.005). VAD use was more likely to result in death in CHD patients. CONCLUSIONS VAD use is less common in CHD patients than in patients without CHD, both at the time of listing and transplantation. Reduced VAD use appears to contribute to lower listing status and organ allocation. These differences have grown more disparate over time. Separate criteria for organ allocation for CHD patients may be justified.
Collapse
Affiliation(s)
- Jill M Gelow
- Heart Failure Transplant Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | | | | | | | | |
Collapse
|
44
|
Garg P, Talwar S, Kothari SS, Rajashekar P, Saxena R, Airan B. Role of Systemic to Pulmonary Artery Shunt after Cavopulmonary Anastomosis. J Card Surg 2013; 28:599-603. [DOI: 10.1111/jocs.12154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pankaj Garg
- Cardiothoracic Centre, All India Institute of Medical Sciences; Ansari Nagar New Delhi India
| | - Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences; Ansari Nagar New Delhi India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences; Ansari Nagar New Delhi India
| | - Palleti Rajashekar
- Cardiothoracic Centre, All India Institute of Medical Sciences; Ansari Nagar New Delhi India
| | - Rachit Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences; Ansari Nagar New Delhi India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences; Ansari Nagar New Delhi India
| |
Collapse
|
45
|
Durham LA, Dearani JA, Burkhart HM, Joyce LD, Cetta F, Cabalka AK, Phillips SD, Sundareswaran K, Farrar D, Park SJ. Application of Computer Modeling in Systemic VAD Support of Failing Fontan Physiology. World J Pediatr Congenit Heart Surg 2013; 2:243-8. [PMID: 23804979 DOI: 10.1177/2150135110397386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the Fontan procedure has been enormously successful in palliation of single-ventricle patients, many seem to experience progressive failure of the Fontan circulation over time. Ventricular assist devices (VADs) have developed into stable platforms for long-term support of adult patients with heart failure. Given the success of axial flow devices, it was hypothesized that the technology could provide clinical benefit to failing Fontan patients. The aim of this study was to use a computer model to evaluate VAD support in failing Fontan physiology. A computer model of Fontan circulation with heart failure was developed and the HeartMate II (HM II) (Thoratec Corp) axial flow ventricular assist device was connected to this model in a systemic configuration to examine its impact. Cardiac catheterization data from 7 patients (8 catheterization studies) with failing Fontan physiology were applied to this model to evaluate the impact of using the HM II in this manner. When the HM II was used in a systemic configuration at 8000 rpm, there was a 35% decrease in the systemic venous pressure in the Fontan circuit and a 63% decrease in pulmonary capillary wedge pressure with a resultant 41% increase in CI. The model also predicted patient-specific parameters where the VAD may not benefit the patient, such as fixed elevated pulmonary vascular resistance, low systemic ventricular end-diastolic pressure, and high unresponsive systemic vascular resistance. These data suggest a potential benefit from application of axial flow VAD technology in the management of failing Fontan physiology. Clinical correlation will allow for refinement of this model as a predictive tool in discerning which patients may benefit from placement of a VAD and what issues must be addressed prior to implanting the device.
Collapse
Affiliation(s)
- Lucian A Durham
- Division of Cardiovascular Surgery, The Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Throckmorton AL, Lopez-Isaza S, Moskowitz W. Dual-pump support in the inferior and superior vena cavae of a patient-specific fontan physiology. Artif Organs 2013; 37:513-22. [PMID: 23692310 DOI: 10.1111/aor.12039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The implementation of simultaneous mechanical cavopulmonary assistance having blood pumps located in both of the vena cavae is investigated as an approach to treating patients with an ailing Fontan physiology. Identical intravascular blood pumps are employed to model the hemodynamic support of a patient-specific Fontan. Pressure flow characteristics, energy gain calculations, and blood damage analyses are assessed for each model. The performance of the dual-support scenario is compared to conditions of mechanical support in the inferior vena cava only and to a nonsupported cavopulmonary circuit. The blood pump in the superior vena cava generates pressures ranging from 1 to 22 mm Hg for flow rates of 1-4 L/min at operating speeds of 1250-2500 rpm. The blood pump in the inferior vena cava produces pressures at levels approximately 20% lower. The blood pumps positively augment the hydraulic energy in the total cavopulmonary connection circuit as a function of flow rate and rotational speed. Scalar stress levels and fluid residence times are at acceptable levels. Damage indices for the dual-support case, however, are elevated slightly above 3.5%. These results suggest that concurrent, mechanical assistance of the inferior vena cava and superior vena cava in Fontan patients has the potential to be beneficial, but additional studies are needed to further explore this approach.
Collapse
Affiliation(s)
- Amy L Throckmorton
- BioCirc Research Laboratory, Department of Mechanical and Nuclear Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA.
| | | | | |
Collapse
|
47
|
Padalino MA, Vida VL, Rito ML, Daliento L, Stellin G. The role of cardiac surgery in adult patients with congenital heart disease. J Cardiovasc Med (Hagerstown) 2013; 14:326-33. [DOI: 10.2459/jcm.0b013e3283542eec] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
48
|
Kanakis M, Lioulias A, Samanidis G, Loukas C, Mitropoulos F. Evolution in Experimental Fontan Circulation: A Review. Ann Thorac Cardiovasc Surg 2013; 19:177-85. [PMID: 23698375 DOI: 10.5761/atcs.ra.13-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | |
Collapse
|
49
|
Delorme Y, Anupindi K, Kerlo AE, Shetty D, Rodefeld M, Chen J, Frankel S. Large eddy simulation of powered Fontan hemodynamics. J Biomech 2012. [PMID: 23177085 DOI: 10.1016/j.jbiomech.2012.10.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children born with univentricular heart disease typically must undergo three open heart surgeries within the first 2-3 years of life to eventually establish the Fontan circulation. In that case the single working ventricle pumps oxygenated blood to the body and blood returns to the lungs flowing passively through the Total Cavopulmonary Connection (TCPC) rather than being actively pumped by a subpulmonary ventricle. The TCPC is a direct surgical connection between the superior and inferior vena cava and the left and right pulmonary arteries. We have postulated that a mechanical pump inserted into this circulation providing a 3-5 mmHg pressure augmentation will reestablish bi-ventricular physiology serving as a bridge-to-recovery, bridge-to-transplant or destination therapy as a "biventricular Fontan" circulation. The Viscous Impeller Pump (VIP) has been proposed by our group as such an assist device. It is situated in the center of the 4-way TCPC intersection and spins pulling blood from the vena cavae and pushing it into the pulmonary arteries. We hypothesized that Large Eddy Simulation (LES) using high-order numerical methods are needed to capture unsteady powered and unpowered Fontan hemodynamics. Inclusion of a mechanical pump into the CFD further complicates matters due to the need to account for rotating machinery. In this study, we focus on predictions from an in-house high-order LES code (WenoHemo(TM)) for unpowered and VIP-powered idealized TCPC hemodynamics with quantitative comparisons to Stereoscopic Particle Imaging Velocimetry (SPIV) measurements. Results are presented for both instantaneous flow structures and statistical data. Simulations show good qualitative and quantitative agreement with measured data.
Collapse
Affiliation(s)
- Y Delorme
- School of Mechanical Engineering, Purdue University, Lafayette, IN, United States.
| | | | | | | | | | | | | |
Collapse
|
50
|
Haggerty CM, Fynn-Thompson F, McElhinney DB, Valente AM, Saikrishnan N, del Nido PJ, Yoganathan AP. Experimental and numeric investigation of Impella pumps as cavopulmonary assistance for a failing Fontan. J Thorac Cardiovasc Surg 2012; 144:563-9. [DOI: 10.1016/j.jtcvs.2011.12.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/22/2011] [Accepted: 12/14/2011] [Indexed: 11/26/2022]
|