1
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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.
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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
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2
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Latorre M, Szafron JM, Ramachandra AB, Humphrey JD. In vivo development of tissue engineered vascular grafts: a fluid-solid-growth model. Biomech Model Mechanobiol 2022; 21:827-848. [PMID: 35179675 PMCID: PMC9133046 DOI: 10.1007/s10237-022-01562-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Methods of tissue engineering continue to advance, and multiple clinical trials are underway evaluating tissue engineered vascular grafts (TEVGs). Whereas initial concerns focused on suture retention and burst pressure, there is now a pressing need to design grafts to have optimal performance, including an ability to grow and remodel in response to changing hemodynamic loads. Toward this end, there is similarly a need for computational methods that can describe and predict the evolution of TEVG geometry, composition, and material properties while accounting for changes in hemodynamics. Although the ultimate goal is a fluid-solid-growth (FSG) model incorporating fully 3D growth and remodeling and 3D hemodynamics, lower fidelity models having high computational efficiency promise to play important roles, especially in the design of candidate grafts. We introduce here an efficient FSG model of in vivo development of a TEVG based on two simplifying concepts: mechanobiologically equilibrated growth and remodeling of the graft and an embedded control volume analysis of the hemodynamics. Illustrative simulations for a model Fontan conduit reveal the utility of this approach, which promises to be particularly useful in initial design considerations involving formal methods of optimization which otherwise add considerably to the computational expense.
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Affiliation(s)
- Marcos Latorre
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA.
- Center for Research and Innovation in Bioengineering, Universitat Politècnica de València, València, 46022, Spain.
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Jay D Humphrey
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, 06520, USA
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3
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Liu X, Kim B, Loke YH, Mass P, Olivieri L, Hibino N, Fuge M, Krieger A. Semi-Automatic Planning and Three-Dimensional Electrospinning of Patient-Specific Grafts for Fontan Surgery. IEEE Trans Biomed Eng 2022; 69:186-198. [PMID: 34156934 PMCID: PMC8753752 DOI: 10.1109/tbme.2021.3091113] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper proposes a semi-automatic Fontan surgery planning method for designing and manufacturing hemodynamically optimized patient-specific grafts. Fontan surgery is a palliative procedure for patients with a single ventricle heart defect by creating a new path using a vascular graft for the deoxygenated blood to be directed to the lungs, bypassing the heart. However, designing patient-specific grafts with optimized hemodynamic performance is a complex task due to the variety of patient-specific anatomies, confined surgical planning space, and the requirement of simultaneously considering multiple design criteria for vascular graft optimization. To address these challenges, we used parameterized Fontan pathways to explore patient-specific vascular graft design spaces and search for optimal solutions by formulating a nonlinear constrained optimization problem, which minimizes indexed power loss (iPL) of the Fontan model by constraining hepatic flow distribution (HFD), percentage of abnormal wall shear stress (%WSS) and geometric interference between Fontan pathways and the heart models (InDep) within clinically acceptable thresholds. Gaussian process regression was employed to build surrogate models of the hemodynamic parameters as well as InDep and [Formula: see text] (conduit model smoothness indicator) for optimization by pattern search. We tested the proposed method on two patient-specific models (n=2). The results showed the automatically optimized (AutoOpt) Fontan models hemodynamically outperformed or at least are comparable to manually optimized Fontan models with significantly reduced surgical planning time (15 hours versus over 2 weeks). We also demonstrated feasibility of manufacturing the AutoOpt Fontan conduits by using electrospun nanofibers.
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Affiliation(s)
- Xiaolong Liu
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA,Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Byeol Kim
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA,Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children’s National Hospital, Washington DC, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington DC, USA
| | - Laura Olivieri
- Division of Cardiology, Children’s National Hospital, Washington DC, USA,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington DC, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA,Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mark Fuge
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA,Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
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4
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Lashkarinia SS, Cicek M, Kose B, Rezaeimoghaddam M, Yılmaz EH, Aydemir NA, Rasooli R, Ozkok S, Yurtseven N, Erdem H, Pekkan K, Sasmazel A. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:1095-1105. [PMID: 35134949 PMCID: PMC9159461 DOI: 10.1093/icvts/ivac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/21/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Murat Cicek
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Banu Kose
- Department of Biomedical Engineering, Istanbul Medipol University, Istanbul, Turkey
| | | | - Emine Hekim Yılmaz
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Reza Rasooli
- Department of Mechanical Engineering, Koc University, Istanbul, Turkey
| | - Sercin Ozkok
- Research Hospital Radiology Department, Medeniyet University Goztepe Training, Istanbul, Turkey
| | - Nurgul Yurtseven
- Anesthesiology, Pediatric Cardiac Intensive Care Unit, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hasan Erdem
- Department of Cardiovascular Surgery, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Kerem Pekkan
- Department of Mechanical Engineering, Koc University, Istanbul, Turkey
- Mechanical Engineering Department Koç University Rumeli Feneri Campus, Sarıyer, 34450 Istanbul, Turkey. Tel: +90-(533)-356-35-95; e-mail: (K.Pekkan)
| | - Ahmet Sasmazel
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
- Corresponding author. Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research Hospital, Tibbiye Cad. No: 13, Uskudar, 34668 Istanbul,Turkey. Tel: +90-(216)-542-44-44; e-mail: (A. Sasmazel)
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5
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Rijnberg FM, van der Woude SFS, van Assen HC, Juffermans JF, Hazekamp MG, Jongbloed MRM, Kenjeres S, Lamb HJ, Westenberg JJM, Wentzel JJ, Roest AAW. Non-uniform mixing of hepatic venous flow and inferior vena cava flow in the Fontan conduit. J R Soc Interface 2021; 18:20201027. [PMID: 33823607 PMCID: PMC8086942 DOI: 10.1098/rsif.2020.1027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Fontan patients require a balanced hepatic blood flow distribution (HFD) to prevent pulmonary arteriovenous malformations. Currently, HFD is quantified by tracking Fontan conduit flow, assuming hepatic venous (HV) flow to be uniformly distributed within the Fontan conduit. However, this assumption may be unvalid leading to inaccuracies in HFD quantification with potential clinical impact. The aim of this study was to (i) assess the mixing of HV flow and inferior vena caval (IVC) flow within the Fontan conduit and (ii) quantify HFD by directly tracking HV flow and quantitatively comparing results with the conventional approach. Patient-specific, time-resolved computational fluid dynamic models of 15 total cavopulmonary connections were generated, including the HV and subhepatic IVC. Mixing of HV and IVC flow, on a scale between 0 (no mixing) and 1 (perfect mixing), was assessed at the caudal and cranial Fontan conduit. HFD was quantified by tracking particles from the caudal (HFDcaudal conduit) and cranial (HFDcranial conduit) conduit and from the hepatic veins (HFDHV). HV flow was non-uniformly distributed at both the caudal (mean mixing 0.66 ± 0.13) and cranial (mean 0.79 ± 0.11) level within the Fontan conduit. On a cohort level, differences in HFD between methods were significant but small; HFDHV (51.0 ± 20.6%) versus HFDcaudal conduit (48.2 ± 21.9%, p = 0.033) or HFDcranial conduit (48.0 ± 21.9%, p = 0.044). However, individual absolute differences of 8.2–14.9% in HFD were observed in 4/15 patients. HV flow is non-uniformly distributed within the Fontan conduit. Substantial individual inaccuracies in HFD quantification were observed in a subset of patients with potential clinical impact.
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Affiliation(s)
- Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology and Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J. M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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6
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Wall Shear Stress Topological Skeleton Analysis in Cardiovascular Flows: Methods and Applications. MATHEMATICS 2021. [DOI: 10.3390/math9070720] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A marked interest has recently emerged regarding the analysis of the wall shear stress (WSS) vector field topological skeleton in cardiovascular flows. Based on dynamical system theory, the WSS topological skeleton is composed of fixed points, i.e., focal points where WSS locally vanishes, and unstable/stable manifolds, consisting of contraction/expansion regions linking fixed points. Such an interest arises from its ability to reflect the presence of near-wall hemodynamic features associated with the onset and progression of vascular diseases. Over the years, Lagrangian-based and Eulerian-based post-processing techniques have been proposed aiming at identifying the topological skeleton features of the WSS. Here, the theoretical and methodological bases supporting the Lagrangian- and Eulerian-based methods currently used in the literature are reported and discussed, highlighting their application to cardiovascular flows. The final aim is to promote the use of WSS topological skeleton analysis in hemodynamic applications and to encourage its application in future mechanobiology studies in order to increase the chance of elucidating the mechanistic links between blood flow disturbances, vascular disease, and clinical observations.
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7
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Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
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Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
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8
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Mirramezani M, Shadden SC. A Distributed Lumped Parameter Model of Blood Flow. Ann Biomed Eng 2020; 48:2870-2886. [PMID: 32613457 PMCID: PMC7725998 DOI: 10.1007/s10439-020-02545-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/03/2020] [Indexed: 01/02/2023]
Abstract
We propose a distributed lumped parameter (DLP) modeling framework to efficiently compute blood flow and pressure in vascular domains. This is achieved by developing analytical expressions describing expected energy losses along vascular segments, including from viscous dissipation, unsteadiness, flow separation, vessel curvature and vessel bifurcations. We apply this methodology to solve for unsteady blood flow and pressure in a variety of complex 3D image-based vascular geometries, which are typically approached using computational fluid dynamics (CFD) simulations. The proposed DLP framework demonstrated consistent agreement with CFD simulations in terms of flow rate and pressure distribution, with mean errors less than 7% over a broad range of hemodynamic conditions and vascular geometries. The computational cost of the DLP framework is orders of magnitude lower than the computational cost of CFD, which opens new possibilities for hemodynamics modeling in timely decision support scenarios, and a multitude of applications of imaged-based modeling that require ensembles of numerical simulations.
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Affiliation(s)
- Mehran Mirramezani
- Mechanical Engineering, University of California, Berkeley, CA, 94720, USA
- Mathematics, University of California, Berkeley, CA, 94720, USA
| | - Shawn C Shadden
- Mechanical Engineering, University of California, Berkeley, CA, 94720, USA.
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9
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Gerrah R, Haller SJ. Computational fluid dynamics: a primer for congenital heart disease clinicians. Asian Cardiovasc Thorac Ann 2020; 28:520-532. [PMID: 32878458 DOI: 10.1177/0218492320957163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Computational fluid dynamics has become an important tool for studying blood flow dynamics. As an in-silico collection of methods, computational fluid dynamics is noninvasive and provides numerical values for the most important parameters of blood flow, such as velocity and pressure that are crucial in hemodynamic studies. In this primer, we briefly explain the basic theory and workflow of the two most commonly applied computational fluid dynamics techniques used in the congenital heart disease literature: the finite element method and the finite volume method. We define important terminology and include specific examples of how using these methods can answer important clinical questions in congenital cardiac surgery planning and perioperative patient management.
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Affiliation(s)
- Rabin Gerrah
- Stanford University, Samaritan Cardiovascular Surgery, Corvallis, OR, USA
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10
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Wei ZA, Johnson C, Trusty P, Stephens M, Wu W, Sharon R, Srimurugan B, Kottayil BP, Sunil GS, Fogel MA, Yoganathan AP, Kappanayil M. Comparison of Fontan Surgical Options for Patients with Apicocaval Juxtaposition. Pediatr Cardiol 2020; 41:1021-1030. [PMID: 32377893 PMCID: PMC7325867 DOI: 10.1007/s00246-020-02353-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
Apicocaval juxtaposition (ACJ) is a rare form of viscerocardiac malpositions in association with single-ventricle congenital heart defects. The Fontan surgery is the common palliation, and possible surgical options include ipsilateral, contralateral, and intra-atrial conduits. Concerns include lower hemodynamic performances or risks of conduit compression by the cardiac mass. This study investigates the hemodynamics and clinical outcomes of ACJ patients and potential surgical improvements. Ten consecutive ACJ patients were included, along with a reference cohort of ten non-ACJ patients. Magnetic resonance images were acquired at 6 ± 0.6 year follow-up for anatomical analysis and hemodynamic assessments using computational fluid dynamics. Metrics of interest are deformation index (DI), indexed power loss (iPL), and hepatic flow distribution (HFDoff). A "virtual" surgery was performed to explore potential hemodynamic improvements using a straightened conduit. DI for ACJ patients fell within the DI range of non-ACJ patients. Contralateral conduits had insignificantly higher iPL (0.070 [0.032,0.137]) than ipsilateral conduits (0.041 [0.013,0.095]) and non-ACJ conduits (0.034 [0.011,0.061]). HFDoff was similar for the ipsilateral (21 [12,35]), contralateral (26 [7,41]), and non-ACJ Fontan conduits (17 [0,48]). Virtual surgery demonstrated that a straightened conduit reduced HFDoff and iPL for the contralateral and ipsilateral conduits, potentially leading to improved clinical outcomes. In this limited sample, the hemodynamic performance of ACJ patients was not significantly different from their non-ACJ counterparts. The use of a straightened conduit option could potentially improve patient outcomes. Additionally, the fear of significant compression of conduits for ACJ patients was unsupported.
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Affiliation(s)
- Zhenglun Alan Wei
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Camille Johnson
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Phillip Trusty
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Morgan Stephens
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Wenjun Wu
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Ritchie Sharon
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Balaji Srimurugan
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | | | - G S Sunil
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Mark A Fogel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
| | - Mahesh Kappanayil
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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Ebrahimi P, Youssef D, Salve G, Ayer J, Dehghani F, Fletcher DF, Winlaw DS. Evaluation of personalized right ventricle to pulmonary artery conduits using in silico design and computational analysis of flow. JTCVS OPEN 2020; 1:33-48. [PMID: 36003197 PMCID: PMC9390144 DOI: 10.1016/j.xjon.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 11/09/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
Objectives Right ventricle to pulmonary artery (RV-PA) conduits are required for the surgical management of pulmonary atresia with ventricular septal defect and truncus arteriosus. Bioengineered RV-PA connections may address some of the shortcomings of homografts and xenografts, such as lack of growth potential and structural deterioration and may be manufactured to accommodate patient-specific anatomy. The aim of this study was to develop a methodology for in silico patient-specific design and analysis of RV-PA conduits. Methods Cross-sectional imaging was obtained from patients with truncus arteriosus (n = 5) and pulmonary atresia with ventricular septal defect (n = 5) who underwent complete repair with a RV-PA conduit. Three-dimensional models of the heart were constructed by segmentation of the right ventricle, existing conduit, branch pulmonary arteries, and surrounding structures. A customized conduit design for each patient was proposed. Computational fluid dynamics analysis was performed and outputs, including wall shear stress and energy loss, were used to compare the performance of the existing conduits and the customized geometries. Results In this study, a methodology for patient-specific analysis of RV-PA conduit in silico was developed. The results of simulations for 10 patients showed between 23% and 56% decrease in the average wall shear stress and between 24% and 87% reduction in average power requirements in customized designs compared with the stenosed conduits, translating into better hemodynamic performance. Conclusions Creation of an optimal conduit for an individual patient can be achieved using surgeon-guided design and computational fluid dynamics analysis. Manufacture of personalized RV-PA conduits may obviate the need for surgical customization to accommodate existing materials and provide superior long-term outcomes.
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Affiliation(s)
- Pegah Ebrahimi
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - David Youssef
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Gananjay Salve
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Julian Ayer
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
| | - David F. Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
| | - David S. Winlaw
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Address for reprints: David S. Winlaw, MBBS, MD, FRACS, Heart Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Corner Hawkesbury Rd and Hainsworth St, Westmead, 2145, Sydney, Australia.
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12
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Telyshev D, Denisov M, Markov A, Fresiello L, Verbelen T, Selishchev S. Energetics of blood flow in Fontan circulation under VAD support. Artif Organs 2019; 44:50-57. [DOI: 10.1111/aor.13564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Dmitry Telyshev
- Institute of Biomedical Systems National Research University of Electronic Technology Zelenograd Russian Federation
- Institute for Bionic Technologies and Engineering I. M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Maxim Denisov
- Institute of Biomedical Systems National Research University of Electronic Technology Zelenograd Russian Federation
| | - Aleksandr Markov
- Institute for Bionic Technologies and Engineering I. M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Libera Fresiello
- Department of Cardiac Surgery Katholieke Universiteit Leuven Leuven Belgium
| | - Tom Verbelen
- Department of Cardiac Surgery Katholieke Universiteit Leuven Leuven Belgium
| | - Sergey Selishchev
- Institute of Biomedical Systems National Research University of Electronic Technology Zelenograd Russian Federation
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13
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Trusty PM, Wei Z, Sales M, Kanter KR, Fogel MA, Yoganathan AP, Slesnick TC. Y-graft modification to the Fontan procedure: Increasingly balanced flow over time. J Thorac Cardiovasc Surg 2019; 159:652-661. [PMID: 31399233 DOI: 10.1016/j.jtcvs.2019.06.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The use of Y-grafts for Fontan completion is hypothesized to offer more balanced hepatic flow distribution (HFD) and decreased energy losses. The purpose of this study was to evaluate the hemodynamic performance of Y-grafts over time using serial cardiac magnetic resonance data and to compare their performance with extracardiac Fontan connections. METHODS Ten Fontan patients with commercially available Y-graft connections and serial postoperative cardiac magnetic resonance data were included in this study. Patient-specific computational fluid dynamics simulations were used to estimate HFD and energy losses. Y-graft performance was compared with 3 extracardiac conduit Fontan groups (n = 10 for each) whose follow-up times straddle the Y-graft time points. RESULTS Y-graft HFD became significantly more balanced over time (deviation from 50% decreased from 18% ± 14% to 8% ± 8%; P = .015). Total cavopulmonary connection resistance did not significantly change. Y-grafts at 3-year follow-up showed more balanced HFD than the extracardiac conduit groups at both the earlier and later follow-up times. Total cavopulmonary connection resistance was not significantly different between any Y-graft or extracardiac conduit group. CONCLUSIONS Y-grafts showed significantly more balanced HFD over a 3-year follow-up without an increase in total cavopulmonary connection resistance, and therefore may be a valuable option for Fontan completion. Additional follow-up data at longer follow-up times are still needed to thoroughly characterize the potential advantages of Y-graft use.
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Affiliation(s)
- Phillip M Trusty
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Zhenglun Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Megan Sales
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Kirk R Kanter
- Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Mark A Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
| | - Timothy C Slesnick
- Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
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14
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Trusty PM, Slesnick TC, Wei ZA, Rossignac J, Kanter KR, Fogel MA, Yoganathan AP. Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions. J Cardiovasc Transl Res 2018; 11:133-144. [PMID: 29340873 PMCID: PMC5910220 DOI: 10.1007/s12265-018-9786-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/05/2018] [Indexed: 11/29/2022]
Abstract
The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.
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Affiliation(s)
- Phillip M Trusty
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Timothy C Slesnick
- Department of Pediatrics, Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- School of Life Science, Fudan University, Shanghai, China
| | - Jarek Rossignac
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kirk R Kanter
- Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark A Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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15
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Best C, Strouse R, Hor K, Pepper V, Tipton A, Kelly J, Shinoka T, Breuer C. Toward a patient-specific tissue engineered vascular graft. J Tissue Eng 2018; 9:2041731418764709. [PMID: 29568478 PMCID: PMC5858675 DOI: 10.1177/2041731418764709] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/20/2018] [Indexed: 12/15/2022] Open
Abstract
Integrating three-dimensional printing with the creation of tissue-engineered vascular grafts could provide a readily available, patient-specific, autologous tissue source that could significantly improve outcomes in newborns with congenital heart disease. Here, we present the recent case of a candidate for our tissue-engineered vascular graft clinical trial deemed ineligible due to complex anatomical requirements and consider the application of three-dimensional printing technologies for a patient-specific graft. We 3D-printed a closed-disposable seeding device and validated that it performed equivalently to the traditional open seeding technique using ovine bone marrow–derived mononuclear cells. Next, our candidate’s preoperative imaging was reviewed to propose a patient-specific graft. A seeding apparatus was then designed to accommodate the custom graft and 3D-printed on a commodity fused deposition modeler. This exploratory feasibility study represents an important proof of concept advancing progress toward a rationally designed patient-specific tissue-engineered vascular graft for clinical application.
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Affiliation(s)
- Cameron Best
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert Strouse
- Research Innovation and Solutions, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kan Hor
- Department of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victoria Pepper
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Tipton
- Advanced Cardiac Imaging Laboratory, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - John Kelly
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher Breuer
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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16
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Verma A, Esmaily M, Shang J, Figliola R, Feinstein JA, Hsia TY, Marsden AL. Optimization of the Assisted Bidirectional Glenn Procedure for First Stage Single Ventricle Repair. World J Pediatr Congenit Heart Surg 2018; 9:157-170. [PMID: 29544408 PMCID: PMC6668725 DOI: 10.1177/2150135117745026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND First-stage single-ventricle palliation is challenging to manage, and significant interstage morbidity and mortality remain. Prior computational and in vitro studies of the assisted bidirectional Glenn (ABG), a novel first-stage procedure that has shown potential for early conversion to a more stable augmented Glenn physiology, demonstrated increased pulmonary flow and oxygen delivery while decreasing cardiac work, as compared to conventional stage-1 alternatives. This study aims to identify optimal shunt designs for the ABG to improve pulmonary flow while maintaining or decreasing superior vena caval (SVC) pressure. METHODS A representative three-dimensional model of a neonatal bidirectional Glenn (BDG) was created, with a shunt connecting the innominate artery to the SVC. The shunt design was studied as a six-parameter constrained shape optimization problem. We simulated hemodynamics for each candidate designs using a multiscale finite element flow solver and compared performance against designs with taper-less shunts, the standalone BDG, and a simplified control volume model. Three values of pulmonary vascular resistance (PVR) of 2.3, 4.3, and 7.1 WUm2 were studied. RESULTS Increases in pulmonary flow were generally accompanied by increases in SVC pressure, except at low PVR (2.3 WUm2), where the optimal shunt geometry achieved a 13% increase in pulmonary flow without incurring any increase in SVC pressure. Shunt outlet area was the most influential design parameter, while others had minimal effect. CONCLUSION Assisted bidirectional Glenn performance is sensitive to PVR and shunt outlet diameter. An increase in pulmonary flow without a corresponding increase in SVC pressure is possible only when PVR is low.
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Affiliation(s)
- Aekaansh Verma
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Mahdi Esmaily
- Center for Turbulence Research, Stanford University, Stanford, CA, USA
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Jessica Shang
- Department of Mechanical Engineering, University of Rochester, Rochester, NY, USA
| | - Richard Figliola
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - Jeffrey A. Feinstein
- Department of Pediatrics, Stanford University School of Medicine, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Tain-Yen Hsia
- Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS-Trust, London, UK
| | - Alison L. Marsden
- Department of Pediatrics, Stanford University School of Medicine, Lucile Salter Packard Children’s Hospital, Palo Alto, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, CA, USA
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17
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Siallagan D, Loke YH, Olivieri L, Opfermann J, Ong CS, de Zélicourt D, Petrou A, Daners MS, Kurtcuoglu V, Meboldt M, Nelson K, Vricella L, Johnson J, Hibino N, Krieger A. Virtual surgical planning, flow simulation, and 3-dimensional electrospinning of patient-specific grafts to optimize Fontan hemodynamics. J Thorac Cardiovasc Surg 2017; 155:1734-1742. [PMID: 29361303 DOI: 10.1016/j.jtcvs.2017.11.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite advances in the Fontan procedure, there is an unmet clinical need for patient-specific graft designs that are optimized for variations in patient anatomy. The objective of this study is to design and produce patient-specific Fontan geometries, with the goal of improving hepatic flow distribution (HFD) and reducing power loss (Ploss), and manufacturing these designs by electrospinning. METHODS Cardiac magnetic resonance imaging data from patients who previously underwent a Fontan procedure (n = 2) was used to create 3-dimensional models of their native Fontan geometry using standard image segmentation and geometry reconstruction software. For each patient, alternative designs were explored in silico, including tube-shaped and bifurcated conduits, and their performance in terms of Ploss and HFD probed by computational fluid dynamic (CFD) simulations. The best-performing options were then fabricated using electrospinning. RESULTS CFD simulations showed that the bifurcated conduit improved HFD between the left and right pulmonary arteries, whereas both types of conduits reduced Ploss. In vitro testing with a flow-loop chamber supported the CFD results. The proposed designs were then successfully electrospun into tissue-engineered vascular grafts. CONCLUSIONS Our unique virtual cardiac surgery approach has the potential to improve the quality of surgery by manufacturing patient-specific designs before surgery, that are also optimized with balanced HFD and minimal Ploss, based on refinement of commercially available options for image segmentation, computer-aided design, and flow simulations.
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Affiliation(s)
- Dominik Siallagan
- Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC; Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Health System, Washington, DC
| | - Laura Olivieri
- Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC; Division of Cardiology, Children's National Health System, Washington, DC
| | - Justin Opfermann
- Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC
| | - Chin Siang Ong
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Diane de Zélicourt
- The Interface Group, Institute of Physiology, University of Zürich, Zurich, Switzerland; Swiss National Centre of Competence in Research, Kidney Control of Homeostasis, Zurich, Switzerland
| | - Anastasios Petrou
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zürich, Zurich, Switzerland; Swiss National Centre of Competence in Research, Kidney Control of Homeostasis, Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | | | - Luca Vricella
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md
| | | | - Narutoshi Hibino
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md.
| | - Axel Krieger
- Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC; Department of Mechanical Engineering, University of Maryland, College Park, Md
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18
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Local Hemodynamic Differences Between Commercially Available Y-Grafts and Traditional Fontan Baffles Under Simulated Exercise Conditions: Implications for Exercise Tolerance. Cardiovasc Eng Technol 2017; 8:390-399. [DOI: 10.1007/s13239-017-0310-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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19
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Wei ZA, Trusty PM, Tree M, Haggerty CM, Tang E, Fogel M, Yoganathan AP. Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning? J Biomech 2016; 50:172-179. [PMID: 27855985 DOI: 10.1016/j.jbiomech.2016.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/15/2022]
Abstract
Cardiovascular simulations have great potential as a clinical tool for planning and evaluating patient-specific treatment strategies for those suffering from congenital heart diseases, specifically Fontan patients. However, several bottlenecks have delayed wider deployment of the simulations for clinical use; the main obstacle is simulation cost. Currently, time-averaged clinical flow measurements are utilized as numerical boundary conditions (BCs) in order to reduce the computational power and time needed to offer surgical planning within a clinical time frame. Nevertheless, pulsatile blood flow is observed in vivo, and its significant impact on numerical simulations has been demonstrated. Therefore, it is imperative to carry out a comprehensive study analyzing the sensitivity of using time-averaged BCs. In this study, sensitivity is evaluated based on the discrepancies between hemodynamic metrics calculated using time-averaged and pulsatile BCs; smaller discrepancies indicate less sensitivity. The current study incorporates a comparison between 3D patient-specific CFD simulations using both the time-averaged and pulsatile BCs for 101 Fontan patients. The sensitivity analysis involves two clinically important hemodynamic metrics: hepatic flow distribution (HFD) and indexed power loss (iPL). Paired demographic group comparisons revealed that HFD sensitivity is significantly different between single and bilateral superior vena cava cohorts but no other demographic discrepancies were observed for HFD or iPL. Multivariate regression analyses show that the best predictors for sensitivity involve flow pulsatilities, time-averaged flow rates, and geometric characteristics of the Fontan connection. These predictors provide patient-specific guidelines to determine the effectiveness of analyzing patient-specific surgical options with time-averaged BCs within a clinical time frame.
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Affiliation(s)
- Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, USA
| | - Phillip M Trusty
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, USA
| | - Mike Tree
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | | | - Elaine Tang
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Mark Fogel
- Division of Cardiology, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA 30313-2412, USA.
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20
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A pulsatile hemodynamic evaluation of the commercially available bifurcated Y-graft Fontan modification and comparison with the lateral tunnel and extracardiac conduits. J Thorac Cardiovasc Surg 2016; 151:1529-36. [DOI: 10.1016/j.jtcvs.2016.03.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 11/22/2022]
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21
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Hsia TY. Taming the Fontan with the Y-graft: A nod and a wink to the great Yu. J Thorac Cardiovasc Surg 2016; 151:1537-9. [DOI: 10.1016/j.jtcvs.2016.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/26/2022]
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22
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Raben JS, Hariharan P, Robinson R, Malinauskas R, Vlachos PP. Time-Resolved Particle Image Velocimetry Measurements with Wall Shear Stress and Uncertainty Quantification for the FDA Nozzle Model. Cardiovasc Eng Technol 2015; 7:7-22. [DOI: 10.1007/s13239-015-0251-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
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23
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Restrepo M, Crouch AC, Haggerty CM, Rossignac J, Slesnick TC, Kanter KR, Yoganathan AP. Hemodynamic Impact of Superior Vena Cava Placement in the Y-Graft Fontan Connection. Ann Thorac Surg 2015; 101:183-9. [PMID: 26431925 DOI: 10.1016/j.athoracsur.2015.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/03/2015] [Accepted: 07/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND A Fontan Y-shaped graft using a commercially available aortoiliac graft has been used to connect the inferior vena cava (IVC) to the pulmonary arteries. This modification of the Fontan procedure seeks to improve hepatic flow distribution (HFD) to the lungs. However, patient-specific anatomical restrictions might limit the space available for graft placement. Altering the superior vena cava (SVC) positioning is hypothesized to provide more space for an optimal connection, avoiding caval flow collision. Computational modeling tools were used to retrospectively study the effect of SVC placement on Y-graft hemodynamics. METHODS Patient-specific anatomies (N = 10 patients) and vessel flows were reconstructed from retrospective cardiac magnetic resonance (CMR) images after Fontan Y-graft completion. Alternative geometries were created using a virtual surgery environment, altering the SVC position and the offset in relation to the Y-graft branches. Geometric characterization and computational fluid dynamics simulations were performed. Hemodynamic factors (power loss and HFD) were computed. RESULTS Patients with a higher IVC return showed less sensitivity to SVC positioning. Patients with low IVC flow showed varied HFD results, depending on SVC location. Balanced HFD values (50% to each lung) were obtained when the SVC lay completely between the Y-graft branches. The effect on power loss was patient specific. CONCLUSIONS SVC positioning with respect to the Y-graft affects HFD, especially in patients with lower IVC flow. Careful positioning of the SVC at the time of a bidirectional Glenn (BDG) procedure based on patient-specific anatomy can optimize the hemodynamics of the eventual Fontan completion.
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Affiliation(s)
- Maria Restrepo
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - A Colleen Crouch
- School of Material Sciences and Engineering, Georgia Institute of Technology, Atlanta
| | - Christopher M Haggerty
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Jarek Rossignac
- College of Computing, Georgia Institute of Technology, Atlanta
| | - Timothy C Slesnick
- Division of Pediatric Cardiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kirk R Kanter
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta.
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25
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Flow simulations and validation for the first cohort of patients undergoing the Y-graft Fontan procedure. J Thorac Cardiovasc Surg 2015; 149:247-55. [DOI: 10.1016/j.jtcvs.2014.08.069] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/19/2014] [Accepted: 08/23/2014] [Indexed: 12/26/2022]
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26
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Restrepo M, Luffel M, Sebring J, Kanter K, Del Nido P, Veneziani A, Rossignac J, Yoganathan A. Surgical planning of the total cavopulmonary connection: robustness analysis. Ann Biomed Eng 2014; 43:1321-34. [PMID: 25316591 DOI: 10.1007/s10439-014-1149-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/04/2014] [Indexed: 11/28/2022]
Abstract
In surgical planning of the Fontan connection for single ventricle physiologies, there can be differences between the proposed and implemented options. Here, we developed a surgical planning framework that help determine the best performing option and ensures that the results will be comparable if there are slight geometrical variations. Eight patients with different underlying anatomies were evaluated in this study; surgical variations were created for each connection by changing either angle, offset or baffle diameter. Computational fluid dynamics were performed and the energy efficiency (indexed power loss-iPL) and hepatic flow distribution (HFD) computed. Differences with the original connection were evaluated: iPL was not considerably affected by the changes in geometry. For HFD, the single superior vena cava (SVC) connections presented less variability compared to the other anatomies. The Y-graft connection was the most robust overall, while the extra-cardiac connections showed dependency to offset. Bilateral SVC and interrupted inferior vena cava with azygous continuation showed high variability in HFD. We have developed a framework to assess the robustness of a surgical option for the TCPC; this will be useful to assess the most complex cases where pre-surgery planning could be most beneficial to ensure an efficient and robust hemodynamic performance.
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Affiliation(s)
- Maria Restrepo
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA
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27
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Kaza AK. Fontan modification with a Y-graft. J Thorac Cardiovasc Surg 2014; 149:246. [PMID: 25298149 DOI: 10.1016/j.jtcvs.2014.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Aditya K Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass.
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28
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Lagrangian postprocessing of computational hemodynamics. Ann Biomed Eng 2014; 43:41-58. [PMID: 25059889 DOI: 10.1007/s10439-014-1070-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
Recent advances in imaging, modeling, and computing have rapidly expanded our capabilities to model hemodynamics in the large vessels (heart, arteries, and veins). This data encodes a wealth of information that is often under-utilized. Modeling (and measuring) blood flow in the large vessels typically amounts to solving for the time-varying velocity field in a region of interest. Flow in the heart and larger arteries is often complex, and velocity field data provides a starting point for investigating the hemodynamics. This data can be used to perform Lagrangian particle tracking, and other Lagrangian-based postprocessing. As described herein, Lagrangian methods are necessary to understand inherently transient hemodynamic conditions from the fluid mechanics perspective, and to properly understand the biomechanical factors that lead to acute and gradual changes of vascular function and health. The goal of the present paper is to review Lagrangian methods that have been used in post-processing velocity data of cardiovascular flows.
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29
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Marsden AL, Bazilevs Y, Long CC, Behr M. Recent advances in computational methodology for simulation of mechanical circulatory assist devices. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2014; 6:169-88. [PMID: 24449607 PMCID: PMC3947342 DOI: 10.1002/wsbm.1260] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/06/2013] [Accepted: 12/16/2013] [Indexed: 11/07/2022]
Abstract
Ventricular assist devices (VADs) provide mechanical circulatory support to offload the work of one or both ventricles during heart failure. They are used in the clinical setting as destination therapy, as bridge to transplant, or more recently as bridge to recovery to allow for myocardial remodeling. Recent developments in computational simulation allow for detailed assessment of VAD hemodynamics for device design and optimization for both children and adults. Here, we provide a focused review of the recent literature on finite element methods and optimization for VAD simulations. As VAD designs typically fall into two categories, pulsatile and continuous flow devices, we separately address computational challenges of both types of designs, and the interaction with the circulatory system with three representative case studies. In particular, we focus on recent advancements in finite element methodology that have increased the fidelity of VAD simulations. We outline key challenges, which extend to the incorporation of biological response such as thrombosis and hemolysis, as well as shape optimization methods and challenges in computational methodology.
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Affiliation(s)
- Alison L Marsden
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
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30
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Marsden AL. Simulation based planning of surgical interventions in pediatric cardiology. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2013; 25:101303. [PMID: 24255590 PMCID: PMC3820639 DOI: 10.1063/1.4825031] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/22/2013] [Indexed: 05/17/2023]
Abstract
Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.
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Affiliation(s)
- Alison L Marsden
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, California 92093, USA
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31
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Arbia G, Corsini C, Esmaily Moghadam M, Marsden AL, Migliavacca F, Pennati G, Hsia TY, Vignon-Clementel IE. Numerical blood flow simulation in surgical corrections: what do we need for an accurate analysis? J Surg Res 2013; 186:44-55. [PMID: 23993199 DOI: 10.1016/j.jss.2013.07.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Computational fluid dynamics has been increasingly used in congenital heart surgery to simulate pathophysiological blood flow, investigate surgical options, or design medical devices. Several commercial and research computational or numerical codes have been developed. They present different approaches to numerically solve the blood flow equations, raising the question whether these numerical codes are equally reliable to achieve accurate simulation results. Accordingly, we sought to examine the influence of numerical code selection in several complex congenital cardiac operations. MATERIAL AND METHODS The main steps of blood flow simulations are detailed (geometrical mesh, boundary conditions, and solver numerical methods) for congenital cardiac operations of increasing complexity. The first case tests different numerical solutions against an analytical, or exact, solution. In the second case, the three-dimensional domain is a patient-specific superior cavopulmonary anastomosis. As an analytical solution does not exist in such a complex geometry, different numerical solutions are compared. Finally, a realistic case of a systemic-to-pulmonary shunt is presented with both geometrically and physiologically challenging conditions. For all, solutions from a commercially available code and an open-source research code are compared. RESULTS In the first case, as the mesh or solver numerical method is refined, the simulation results for both codes converged to the analytical solution. In the second example, velocity differences between the two codes are greater when the resolution of the mesh were lower and less refined. The third case with realistic anatomy reveals that the pulsatile complex flow is very similar for both codes. CONCLUSIONS The precise setup of the numerical cases has more influence on the results than the choice of numerical codes. The need for detailed construction of the numerical model that requires high computational cost depends on the precision needed to answer the biomedical question at hand and should be assessed for each problem on a combination of clinically relevant patient-specific geometry and physiological conditions.
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Affiliation(s)
- Gregory Arbia
- INRIA Paris-Rocquencourt, Le Chesnay Cedex, France; UPMC Univ Paris 6, Laboratoire Jacques-Louis Lions, Paris, France
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