AvalonElite Double Lumen Cannula for Total Cavopulmonary Assist in Failing Fontan Sheep Model with Valved Extracardiac Conduit

Abstract

The AvalonElite double lumen cannula (DLC) provides total cavopulmonary assist (CPA) in failing Fontan sheep, but recirculation limits reliability. To improve CPA performance, a two-valve extracardiac conduit (ECC) was used to bracket infusion blood toward pulmonary artery (PA). A total cavopulmonary connection with failing Fontan circulation adult sheep model was created with valved ECC (n = 6). The valved ECC was connected to superior/inferior venae cavae (SVC/IVC) and right PA. The AvalonElite DLC was inserted from right jugular vein with infusion opening between the ECC valves. The DLC drainage lumen withdrew blood from SVC/IVC, and the infusion lumen returned blood to ECC. A failing Fontan sheep model with valved ECC was successfully created. Central venous pressure increased from 9 ± 1 to 17 ± 1 mm Hg, systolic arterial pressure decreased from 103 ± 9 to 51 ± 13 mm Hg, and cardiac output decreased from 3.6 ± 0.3 to 1.4 ± 0.2 L/min. Serum lactate significantly increased, indicating poor tissue perfusion. At 4 L/min pumping flow, the AvalonElite DLC returned hemodynamics/lactate to baseline levels throughout 6 hour CPA. Necropsy revealed intact/well-functioning ECC valves and well-positioned DLC with no visible thrombosis. The AvalonElite DLC provides reliable CPA performance in failing Fontan sheep with valved ECC.

Study on the optimal elastic modulus of flexible blades for right heart assist device supporting patients with single-ventricle physiologies

“…Effective power assistance was only possible by completely separating the inlet and outlet tubes. Wang et al ( 8 , 9 ) used dual-lumen catheters and extracorporeal blood pumps for Fontan support. The successful assistance achieved was also due to the use of valves or umbrella-like membranes that separated the inlet and outlet of the dual-lumen catheters.…”

“…Animal studies revealed that this setup effectively improved hemodynamics in failing Fontan sheep. Subsequently, in 2019, Wang et al ( 9 ) combined a double-lumen cannula with a two-valve extracardiac conduit and CentriMag to achieve effective support. In 2016, Gandolfo et al ( 10 ) designed a T-shaped mechanically assisted TCPC model using the Jarvik Child 2,000 axial pump (Jarvik Heart, New York, NY, USA), which showed promising results in vivo .…”

Percutaneous Cavopulmonary Assist: From Design to 96 Hour Survival in Lethal Cavopulmonary Failure Sheep

“…In the last decade, we have established a fully reproducible (>50 sheep) CPF sheep model. 6,8,14 In this sheep model, the clinical TCPC procedure is duplicated, and a blood flow restriction between ECC and right PA mimics clinical scenario of increased PVR. The resulting CPF is unsurvivable without CPA, making this sheep model excellent for CPA device testing.…”

Failing Fontan cardiovascular support: Review

“…This procedure has successfully allowed the single ventricle to support life, benefiting thousands of patients. However, both ventricular and cavopulmonary failure, as well as complications, can occur, with the 25‐year mortality as high as 30% 3 …”

“…However, both ventricular and cavopulmonary failure, as well as complications, can occur, with the 25-year mortality as high as 30%. 3 Complications post-Fontan procedure include stroke, cirrhosis, protein-losing enteropathy, thrombosis, and arrhythmia. 4 The possibility of developing pneumonia or heart failure is also ever-present, and the risk of these complications increases with time.…”