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 patientspecific 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 ¼ 5) and pulmonary atresia with ventricular septal defect (n ¼ 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 longterm outcomes. (JTCVS Open 2020;1:33-48) Initial conduit and customized design showing improved wall shear stress distribution.
CENTRAL MESSAGEPatient-specific design and in silico testing of novel RV-PA conduits is feasible and will complement emerging RV-PA technologies.
PERSPECTIVERight ventricle to pulmonary artery conduits are an essential part of many pediatric cardiac reconstructions. We demonstrate that in silico patientspecific design and analysis of the proposed conduit is feasible. Iterative customization improves hemodynamic performance with potential benefits in reducing right ventricle work and durability. This approach may be employed with new generation polymer-based conduits.See Commentary on page 49.
Bioprosthetic valves manufactured for the aortic position work well as pulmonary replacements. The lower transvalve pressure across pulmonary valves has implications for valve competence and sizing.
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