Computational Modeling of the Penn State Fontan Circulation Assist Device

Good, Bryan C.; Ponnaluri, Sailahari V.; Weiss, Jason; Manning, Keefe B.

doi:10.1097/mat.0000000000001708

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…A total of 10 trials [5][6][7][8][9][10][11][12][13][14] were identified which fulfilled the inclusion criteria as well as the needed outcome parameters; while another 10 trials were excluded due to unmet outcomes [15][16][17][18][19][20][21][22]. Some of the included trials involved different settings in terms of pump speed or terms of device design, a total of 23 sets of adjustments were finally analyzed in terms of their impact on IVC and SVC pressure and resultant flow rate.…”

Section: Resultsmentioning

confidence: 99%

“…The connecting chamber and the compression device require a surgical approach for their insertion, while intravascular pump designs are inserted via a transcatheter route. This has been reflected in the number of in-vivo trials across the three designs, which clearly shows that most of the trials (67%) employed in the intravascular design were in-vivo compared to 0% of compression devices' trials and 9% of the connecting chamber designs [5][6][7][8][9][10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…The power consumption was not mentioned in the examined papers, but it largely depends on the pump speed. It was concluded that the impeller, or the intravascular pump, functions at the highest pump speed rendering its power supply under question [5][6][7][8][9][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical trials have shown that fluid shear stresses within the assist devices consistently stayed below typical thresholds associated with red blood cell damage. Nevertheless, according to, Good et al (2022), the risk of hemolysis was not observed with the compression device and was seen most frequently in the impeller, or the intravascular device [9].…”

Section: Discussionmentioning

confidence: 99%

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Fontan Assist Devices, a Systematic Review of Twenty Years of Experimental and In Vivo Trials

AbdelMassih,

Allami,

AlTatari

et al. 2024

Preprint

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Background:Fontan completion is the last stage of univentricular repair, which drains the inferior vena cava against gravity to a higher-pressure pulmonary arterial circulation. The passivity and anti-gravity nature of this circulation render a failing Fontan, not an uncommon encounter, twenty years ago, Rodefeld and colleagues, decided to explore the feasibility of vascular pumps to support the passive nature of Fontan circulation, and since then, trials are still ongoing, and we aimed through this review to wrap up the results of these trials. Methods:A literature review has been conducted, to identify any in vivo or in vitro trial of a Fontan assist device. Several outcome parameters determined whether the trial will be included or not in this review, including, the flow rate of a pump if applicable, the number of compressions per minute if a compression device has been used, the resultant flow rate, the inferior and superior vena cava pressures, associated with each setting of the respective device, and any evidence of hemolysis or clotting within the circuit. Results:A total of ten trials have been included, with 23 different settings. Three designs have been identified, out of which two fall within the pump design, namely the connecting chamber and the intravascular pump designs; only one trial explored the possible use of a compression device. The commonest design encountered in in-vivo trials was the intravascular pump (67%). No reports of significant hemolysis or thrombosis were found. An increasing flow rate beyond 5L/min was associated with a negative outcome in the connecting chamber design, increasing upstream pressure in the SVC, while intravascular pumps did not display this limitation. Conclusion:Univentricular heart patients are a relatively small population, with very extensive needs, despite twenty years of trials, no study has yet concluded the optimal design or settings for a Fontan assist device. In this review, we identified that the intravascular pump remains the most practical design, due to its easy mode of insertion, and that it is not faced with the limitation or risk of increasing upstream resistance. There is still a long way to conclude its use as other designs such as compression devices have not yet been fully studied.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Fontan Assist Devices, a Systematic Review of Twenty Years of Experimental and In Vivo Trials

AbdelMassih,

Allami,

AlTatari

et al. 2024

Preprint

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“…Investigative collaboration with bioengineers and mathematicians has opened a new horizon in the research for mechanical circulatory support even in Fontan circulation, resulting in a large number of publications on the topic (177,238,(246)(247)(248)(249)(250)(251).…”

Section: Mathematical and Computational Fluid Dynamic Studiesmentioning

confidence: 99%

Narrative review of single ventricle: where are we after 40 years?

Corno¹,

Findley²,

Salazar³

2023

Transl Pediatr

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Background and Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.

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Switching the Left and the Right Hearts: A Novel Bi-ventricle Mechanical Support Strategy with Spared Native Single-Ventricle

Şişli,

Yıldırım,

Aka

et al. 2023

Ann Biomed Eng

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Mechanical circulatory support (MCS) is used as a bridge-to-heart transplantation for end-stage failing Fontan patients with single-ventricle (SV) circulation. Donor shortage and complexity of the single-ventricle circulation physiology demands novel circulatory support systems and alternative solutions. An out-of-the-box circulation concept in which the left and right ventricles are switched with each other inspired a novel bi-ventricle MCS configuration for the "failing" Fontan patients. In the proposed configuration, the systemic circulation is maintained by a conventional mechanical ventricle assist device while the venous circulation is delegated to the native SV. This approach spares the SV and puts it to a new use at the right-side providing the most needed venous flow pulsatility. To analyze its feasibility and performance, 8 realistic Fontan circulation scenarios have been studied via a multi-compartmental lumped parameter cardiovascular model (LPM). Model is developed specifically for simulating the SV circulation and validated against pulsatile mock-up flow loop measurements for the ideal (Fontan), failed (VD) and assisted Fontan (PVR-cmcs) scenarios. The proposed surgical configuration maintained the cardiac index (3-3.5 l/min/m 2 ) providing a normal mean systemic arterial pressure. For a failed SV with low ejection fraction (EF=26%), representing a typical systemic failure, proposed configuration introduced a venous/pulmonary pulsatility of ~28 mmHg and a drop of 2 mmHg in central venous pressure (CVP) with acceptable pulmonary artery pressures (17.5 mmHg). In the pulmonary vascular resistance (PVR) failure model, it provided approximately 5 mmHg drop in CVP with venous/pulmonary pulsatility reaching ~22 mmHg. For high PVR failure case with a healthy SV (EF = 44%) pulmonary hypertension is likely to occur, indicating a need for precise functional assessment of the failed-ventricle before it is considered for the proposed arrangement.Comprehensive in vitro and in silico results encourage this concept as an economical alternative to the conventional bi-ventricle MCS pending animal experiments.

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Computational Modeling of the Penn State Fontan Circulation Assist Device

Cited by 7 publications

References 32 publications

Fontan Assist Devices, a Systematic Review of Twenty Years of Experimental and In Vivo Trials

Fontan Assist Devices, a Systematic Review of Twenty Years of Experimental and In Vivo Trials

Narrative review of single ventricle: where are we after 40 years?

Switching the Left and the Right Hearts: A Novel Bi-ventricle Mechanical Support Strategy with Spared Native Single-Ventricle

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