Evolution in Experimental Fontan Circulation: A Review

Kanakis, Meletios; Lioulias, Achilleas; Samanidis, George; Loukas, Constantinos; Mitropoulos, Fotios

doi:10.5761/atcs.ra.13-00017

Cited by 5 publications

(3 citation statements)

References 43 publications

(74 reference statements)

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“…In this study, successful Fontan support was defined as the ability to simultaneously decrease IVC pressure (Fontan pressure) by 5 mm Hg and increase CO to 4.25 L/min (a 0.75 L/min increase) without increasing SVC pressure. [10][11][12] If these criteria were met, the FAD configuration was deemed successful. Identical failing Fontan baseline conditions were first established in each scenario.…”

Section: Experimental Protocolmentioning

confidence: 99%

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

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Maher

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Section: Experimental Protocolmentioning

confidence: 99%

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

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Maher

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Section: Experimental Protocolmentioning

confidence: 99%

In Vitro Examination of the VentriFlo True Pulse Pump for Failing Fontan Support

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Vincent³

et al. 2018

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The current methodology of Fontan palliation results in a one "pump" circulatory system with passive flow to the lungs. Inherent hemodynamic differences exist between a biventricular circulatory system and this modified physiology, leading to a host of long-term complications. Mechanical circulatory support (MCS) is a potential option to combat these pathophysiological conditions. In this study, we examine the VentriFlo True Pulse Pump as a MCS option to support a failing Fontan patient. An in vitro circulatory loop was used to model a failing Fontan patient, reproducing pathophysiological pressures and flow rates. The VentriFlo True Pulse Pump was positioned as a right sided support, testing multiple cannulation and baffle restriction strategies, as well as various pumping parameters including flow rate, frequency, stroke volume and the ejection to filling time ratio. A 10 mm Hg decrease in IVC pressure and 0.75 L/min increase in cardiac output were achieved using a complete baffle restriction strategy. Additional cannulation and banding strategies were not as successful. Pump flow rate and frequency significantly impacted hemodynamics, while the ejection to filling time ratio did not. Though not ideal, complete baffle restriction was necessary to achieve successful support. The ability to tune individual pumping parameters for a given MCS device will have a substantial impact on the pressures and flow augmentation seen in a Fontan circulation. Both future pump design and off-label VADs for Fontan use should consider the pump configuration and parameter combinations presented here, which offered successful support. Key Words: Congenital heart disease-Fontan-Mechanical circulatory support-Single ventricle-Ventricular assist device.The current methodology of Fontan palliation results in a one "pump" circulatory system with passive, nonpulsatile flow to the lungs. Inherent hemodynamic differences exist between a biventricular circulatory system and this modified physiology, including elevated central venous pressures (CVP) and insufficient cardiac output (CO), as well as a myriad of ventricular function, impedance and congestion issues (1-5). As these patients survive into early adulthood, numerous long-term complications are common, with liver disease, protein losing enteropathy and plastic bronchitis among the most prevalent (3,(6)(7)(8)(9).In order to moderate these long-term problems, a circulatory correction rather than palliation is needed; and with a limited number of immediate heart transplants available, mechanical circulatory support (MCS) has become a potential option as a bridge-to-transplant therapy. However, the use of MCS in Fontan patients poses unique challenges including low preload and afterload, an absent upstream capacitance chamber, and potentially difficult anatomic implementation (10).The two approaches for Fontan MCS include (i) designing a new pump specifically for Fontan use, or (ii) using an existing pump off-label with the hope that it can provide adequate support in an environment othe...

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“…In addition to the pediatric TAH studies, our team is currently working on the development and testing of a small implantable blood pump designed to provide long‐term mechanical right heart support for patients who exhibit progressive Fontan failure. The establishment of Fontan circulation on an experimental animal model with a pre‐existing normal heart is challenging . Van Puyvelde et al has successfully created a chronic sheep model of the Fontan circulation without pump implantation .…”

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confidence: 99%

Animal Models for Pediatric Mechanical Circulatory Support Research at Penn State Health

et al. 2018

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Evolution in Experimental Fontan Circulation: A Review

Cited by 5 publications

References 43 publications

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support

In Vitro Examination of the VentriFlo True Pulse Pump for Failing Fontan Support

Animal Models for Pediatric Mechanical Circulatory Support Research at Penn State Health

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