A modified LVAD technique to augment caval and pulmonary arterial blood flow in the “failing Fontan” circulation

Swartz, Michael F.; DiVincenti, Louis; Smith, Karen; Westcott, Robin; Belmont, Kevin; Harris, William R.; Gensini, Francisco; Alfieris, George M.

doi:10.1111/jocs.12931

Cited by 5 publications

(8 citation statements)

References 21 publications

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

Section: Surgical Classificationmentioning

confidence: 99%

“…Rodefeld et al 20 18 BT Paraflow (A-Med Systems West Sacramento, CA, USA) Riemer et al 19,a HeartMate II (Abbott, Abbott Park, IL, USA) Rodefeld et al 21 BT Paraflow Sinha et al 31,a CPB Rotaflow Pump (Maquet Inc, Wayne, NJ, USA) Swartz et al 22 HeartMate II Tanoue et al 15 Centrifugal pump (unknown) Tsuda et al 23 HeartMate II Wei et al 32 Impella LD (Abiomed Inc., Danvers, MA, USA)…”

Section: Hemodynamic Parametersmentioning

confidence: 99%

“…In this study, we found that the connection of the caval veins to the main PA (Y/T shape) is the most common approach (n ¼ 18), followed by the connection to the right PA (cross-like shape; n ¼ 5). Creating a bidirectional cavopulmonary anastomosis (¼Glenn anastomosis) in sheep is surgically more challenging than connecting the SVC to the pulmonary trunk as the 10 Coronary flow ejected in PA (n ¼ 9) Derk et al 27 Kanakis et al 28 Gandolfo et al 16 Klautz et al 29 Riemer et al 19 Kocyildirım et al 17 Swartz et al 22 Macé et al 11 Tsuda et al 23 Myers et al 18 Wang et al 24 Rodefeld et al 20 Wang et al 25 Rodefeld et al 21 Wang et al 26 Szabo et al 13 Wei et al 32 Szabo et al 14 Tanoue et al 15 ASD (n ¼ 2)…”

Section: Surgical Creation Of An Extracardiac Tcpcmentioning

confidence: 99%

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

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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

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Section: Surgical Classificationmentioning

confidence: 99%

Section: Hemodynamic Parametersmentioning

confidence: 99%

Section: Surgical Creation Of An Extracardiac Tcpcmentioning

confidence: 99%

See 1 more Smart Citation

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

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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“…Unfortunately, heart transplants are not readily available due to a shortage of donors, and patients with failing Fontan circulation are often too sick for heart transplant eligibility. Moreover, the number of failing Fontan patients is expected to increase by 60% in the upcoming decade 6 . To reduce morbidity and mortality, better long‐term circulatory support is required for acute recoverable events such as pneumonia or flu, and as a bridge to transplant from unrecoverable events such as cardiac failure.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the number of failing Fontan patients is expected to increase by 60% in the upcoming decade. 6 To reduce morbidity and mortality, better long-term circulatory support is required for acute recoverable events such as pneumonia or flu, and as a bridge to transplant from unrecoverable events such as cardiac failure.…”

mentioning

confidence: 99%

Failing Fontan cardiovascular support: Review

Zwischenberger

Breetz

Ballard-Croft

et al. 2022

Journal of Cardiac Surgery

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Background Although all congenital heart defects (CHD) present unique challenges, univentricular CHD are especially challenging given the difficulty of passively perfusing pulmonary blood flow. Three surgical procedures are required within the first years of life, with the final completing a Fontan circulation in which the inferior vena cava is connected to the pulmonary artery and previously connected superior vena cava. This allows passive venous return to the pulmonary circulation then flow into the single ventricle for systemic circulation. Methods Although a Fontan provides successful palliation for two to three decades, many complications can arise as pulmonary resistance must remain low to allow adequate forward flow. Eventually, the failing Fontan circulation requires temporary support as the patient awaits a heart transplant. We reviewed PubMed, Google Scholar, and U. Kentucky library for different techniques evaluated to support a failing Fontan circulation. Results Multiple technologies have been developed as a bridge to transplant to decrease morbidity. Innovative types of extracorporeal membrane oxygenation, ventricular assist devices, and total artificial hearts have been attempted in laboratory settings as well as in Fontan patients with varying degrees of success. This article emphasizes the strengths and weaknesses of each technology in the context of Fontan physiology. Conclusion The end game for these patients remains a heart transplant. Without easy access to donors, each of the options discussed is a potential bridge to limit morbidity and mortality until a suitable donor heart becomes available.

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Control strategy to enhance pulmonary vascular pulsatility for implantable cavopulmonary assist devices: A simulation study

Wang

Peng

Qin

et al. 2021

Biomedical Signal Processing and Control

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A modified LVAD technique to augment caval and pulmonary arterial blood flow in the “failing Fontan” circulation

Abstract: These findings suggest that the HMII may be modified to provide caval/pulmonary circulatory support for the failing Fontan circulation.

Cited by 5 publications

References 21 publications

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

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

Failing Fontan cardiovascular support: Review

Control strategy to enhance pulmonary vascular pulsatility for implantable cavopulmonary assist devices: A simulation study

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