A Numerical Simulation Comparing a Cavopulmonary Assist Device and VA ECMO for Failing Fontan Support

Hsu, Po-Lin; Wang, Dongfang; Ballard-Croft, Cherry; Xiao, Da-Wei; Zwischenberger, Joseph B.

doi:10.1097/mat.0000000000000560

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…Through simulations, we showed that a proper implementation of an arterial pump in the right circulation could benefit the Fontan hemodynamics. We constructed the failing Fontan model employing clinical data available in the literature and found that the failing circulation model to be in general agreement with previous reports [16], [18], [35]. Our model sensitivity analysis showed the association of the hemodynamic parameters (e.g.…”

Section: Discussionsupporting

confidence: 84%

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Farahmand

Kavarana

Kung

2020

IEEE Trans. Biomed. Eng.

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Fontan patients often develop circulatory failure and are in desperate need of a therapeutic solution. A blood pump surgically placed in the cavopulmonary pathway can substitute the function of the absent sub-pulmonary ventricle by generating a mild pressure boost. However, there is currently no commercially available device designed for the cavopulmonary application; and the risks and benefits of implanting a ventricular assist device (VAD) originally designed for the left ventricular application on the right circulation of failing Fontan patients is not yet clear. Moreover, further research is needed to compare the hemodynamics between the two clinically-considered surgical configurations for cavopulmonary assist, with Full and IVC Support corresponding to the entire venous return or only the inferior venous return, respectively, being routed through the VAD. In this study, we used a numerical model of the failing Fontan physiology to evaluate the Fontan hemodynamic response to a left VAD during the IVC and Full support scenarios. We observed that during Full support the VAD improved the cardiac output while maintaining blood pressures within safe ranges, and lowered the IVC pressure to <15mmHg; however, we found a potential risk of lung damage at higher pump speeds due to the excessive pulmonary pressure elevation. IVC support, on the other hand, did not benefit the hemodynamics in the patient cases simulated, resulting in the superior vena cava pressure increasing to an unsafe level of >20 mmHg. The findings in this study may be helpful to surgeons for recognizing the risks of a cavopulmonary VAD and developing coherent clinical strategies for the implementation of cavopulmonary support. Index Terms-Ventricular assist device (VAD), lumped parameter network model, congenital heart disease, Fontan

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Section: Discussionsupporting

confidence: 84%

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Farahmand

Kavarana

Kung

2020

IEEE Trans. Biomed. Eng.

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“…The lower limb circulation is further divided into the iliac artery and arterial and venous networks of the leg, using the same technique as published in our 13-compartments Fontan circulation. 3…”

Section: Methodsmentioning

confidence: 99%

“…The simulation based on LPM greatly reduced computational expense compared to 3-dimensional computational fluid dynamics 1 and can produce hemodynamics in agreement with clinical data. 2,3…”

Section: Introductionmentioning

confidence: 99%

An analytic method to investigate hemodynamics of the cardiovascular system – single ventricular system

Zhu,

Ge,

et al. 2023

Int J Artif Organs

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Based on the lumped parameter model (LPM) of the cardiovascular system, an analytic method is developed to derive its hemodynamics theoretically. As soon as the LPM (a series of differential equations) is solved, the hemodynamics would be obtained immediately. However, because of time-varying ventricular elastance and high order, it is difficult to solve analytically. Through simplifying the LPM, the original biventricular system with continuously varying elastance becomes a single ventricular system with discrete elastance which keeps constant during the systolic or diastolic phase. As a consequence, the original time-varying and high-order system becomes a time-invariant and first-order system during each phase. From the analytic solutions of the simplified system, a set of algebraic equations is carried out. Then the hemodynamics are obtained from the solutions of the algebraic equations. The nature of the algebraic equations is an integral form of the differential equations. A connection between the equations and PV loop is established. All of these equations are deduced based on the idealization of replacing the continuous elastance with the discrete elastance. However, there exist algebraic equations, that can be derived directly from volume conservation, still hold for the case of continuous elastance. As a preliminary application, the method is utilized to deduce the hemodynamics of left heart failure (LHF). The results show that the theoretical hemodynamics of LHF are coincident with simulated results. The analytic method can be generalized to investigate biventricular system. A program for developing a more general framework is presented in the last part.

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“…Mathematical modeling and comparison of VV ECMO with DLC to other cardiopulmonary assist device designs further aided development. 13 Recently, a DLC-based ambulatory cardiopulmonary assist (CPA) system for a failing Fontan sheep model was developed by Wang and colleagues. 14 The percutaneous DLC CPA is designed for insertion and advancement into the right internal jugular vein, to the SVC, through the Fontan connection, and finally into the IVC.…”

Section: Modified Veno-venous Ecmo Techniquesmentioning

confidence: 99%

“…While this allows more consistent cardiopulmonary perfusion, the risk of thrombosis in stagnant areas persists and must be considered. Mathematical modeling and comparison of VV ECMO with DLC to other cardiopulmonary assist device designs further aided development 13 …”

Section: Modified Veno‐venous Ecmo Techniquesmentioning

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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A Numerical Simulation Comparing a Cavopulmonary Assist Device and VA ECMO for Failing Fontan Support

Cited by 11 publications

References 23 publications

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

Risks and Benefits of Using a Commercially Available Ventricular Assist Device for Failing Fontan Cavopulmonary Support: A Modeling Investigation

An analytic method to investigate hemodynamics of the cardiovascular system – single ventricular system

Failing Fontan cardiovascular support: Review

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