In vitro measurement of hepatic flow distribution in Fontan vascular conduits: Towards rapid validation techniques

Rasooli, Reza; Kose, Banu; Lashkarinia, S Samaneh; Şaşmazel, Ahmet; Pekkan, Kerem

doi:10.1016/j.jbiomech.2022.111092

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…As the population of late survivors with Fontan circulation continues to grow and donor organ shortages persist, the management of Fontan failure has become a significant clinical challenge, and innovative strategies are urgently required 15 . Attempts aimed at addressing the Fontan paradox have primarily focused on optimizing the TCPC anatomy to improve blood energetics through novel surgical pathways, such as Y-grafts 16 – 21 . These modifications, however, fail to address the physiologic deficit of a ventricle as the right-side driving pump and thus have little impact on the Fontan outcomes 22 .…”

Section: Introductionmentioning

confidence: 99%

In vitro hemodynamic performance of a blood pump for self-powered venous assist in univentricular hearts

Rasooli,

Holmstrom,

Giljarhus

et al. 2024

Sci Rep

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Univentricular heart anomalies represent a group of severe congenital heart defects necessitating early surgical intervention in infancy. The Fontan procedure, the final stage of single-ventricle palliation, establishes a serial connection between systemic and pulmonary circulation by channeling venous return to the lungs. The absence of the subpulmonary ventricle in this peculiar circulation progressively eventuates in failure, primarily due to chronic elevation in inferior vena cava (IVC) pressure. This study experimentally validates the effectiveness of an intracorporeally-powered venous ejector pump (VEP) in reducing IVC pressure in Fontan patients. The VEP exploits a fraction of aortic flow to create a jet-venturi effect for the IVC, negating the external power requirement and driveline infections. An invitro Fontan mock-up circulation loop is developed and the impact of VEP design parameters and physiological conditions is assessed using both idealized and patient-specific total cavopulmonary connection (TCPC) phantoms. The VEP performance in reducing IVC pressure exhibited an inverse relationship with the cardiac output and extra-cardiac conduit (ECC) size and a proportional relationship with the transpulmonary pressure gradient (TPG) and mean arterial pressure (MAP). The ideal VEP with fail-safe features provided an IVC pressure drop of 1.82 ± 0.49, 2.45 ± 0.54, and 3.12 ± 0.43 mm Hg for TPG values of 6, 8, and 10 mm Hg, respectively, averaged over all ECC sizes and cardiac outputs. Furthermore, the arterial oxygen saturation was consistently maintained above 85% during full-assist mode. These results emphasize the potential utility of the VEP to mitigate elevated venous pressure in Fontan patients.

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Section: Introductionmentioning

confidence: 99%

In vitro hemodynamic performance of a blood pump for self-powered venous assist in univentricular hearts

Rasooli,

Holmstrom,

Giljarhus

et al. 2024

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…As the population of late survivors with Fontan circulation continues to grow and donor organ shortages persist, the management of Fontan failure has become a signi cant clinical challenge, and innovative strategies are urgently required [15]. Attempts aimed at addressing the Fontan paradox have primarily focused on optimizing the TCPC anatomy to improve blood energetics through novel surgical pathways, such as Y-grafts [16][17][18][19][20][21]. These modi cations, however, fail to address the physiologic de cit of a ventricle as the right-side driving pump and thus have little impact on the Fontan outcomes [22].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Hemodynamic Performance of a Blood Pump for Self-powered Venous Assist in Univentricular Hearts

Rasooli,

Holmstrom,

Giljarhus

et al. 2023

Preprint

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Univentricular heart anomalies represent a group of severe congenital heart defects necessitating early surgical intervention in infancy. The Fontan procedure, the final stage of single-ventricle palliation, establishes a serial connection between systemic and pulmonary circulation by channeling venous return to the lungs. The absence of the subpulmonary ventricle in this peculiar circulation progressively eventuates in failure, primarily due to chronic elevation in inferior vena cava (IVC) pressure. This study experimentally validates the effectiveness of an intracorporeally-powered venous ejector pump (VEP) in reducing IVC pressure in Fontan patients. The VEP exploits a fraction of aortic flow to create a jet-venturi effect for the IVC, negating the external power requirement and driveline infections. A multi-scale in-vitro Fontan mock-up circulation loop is developed and the impact of VEP design parameters and physiological conditions is assessed using both idealized and patient-specific total cavopulmonary connection (TCPC) phantoms. The VEP performance in reducing IVC pressure exhibited an inverse relationship with the cardiac output and extra-cardiac conduit (ECC) size and a proportional relationship with the transpulmonary pressure gradient (TPG) and mean arterial pressure (MAP). The ideal VEP with fail-safe features provided an IVC pressure drop of 1.82 ± 0.49, 2.45 ± 0.54, and 3.12 ± 0.43 mm Hg for TPG values of 6, 8, and 10 mm Hg, respectively, averaged over all ECC sizes and cardiac outputs. Furthermore, the arterial oxygen saturation was consistently maintained above 85% in all conditions. These results emphasize the potential utility of the VEP to mitigate elevated venous pressure in Fontan patients.

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In vitro investigation of axial mechanical support devices implanted in the novel convergent cavopulmonary connection Fontan

Cleveland,

Contento,

Mass

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The two opposing inflows and two outflows in a total cavopulmonary connection (TCPC) makes mechanical circulatory support (MCS) extremely challenging. We have previously reported a novel convergent cavopulmonary connection (CCPC) Fontan design that improves baseline characteristics and provides a single inflow and outflow, thus simplifying MCS. This study aims to assess the feasibility of MCS of this novel configuration using axial flow pumps in an in vitro benchtop model. METHODS Three-dimensional (3D) segmentations of twelve single ventricle patients (Body Surface Area (BSA) 0.5–1.75 m2) were generated from cardiovascular magnetic resonance images. The CCPC models were designed by connecting the inferior vena cava (IVC) and superior vena cava (SVC) to a shared conduit ascending to the pulmonary arteries (PA), optimized in silico. The twelve TCPC and their corresponding CCPC models underwent in vitro benchtop characterization. Two MCS devices were used, the Impella RP® and the PediPump. RESULTS MCS successfully and symmetrically reduced the pressure in both vena cavae more than 20 mmHg. The devices improved the hepatic flow distribution (HFD) balance of all CCPC models (Impella RP® P = 0.045, PediPump P = 0.055). CONCLUSIONS The CCPC Fontan design provides a feasible MCS solution for a failing Fontan by balancing HFD and symmetrically decompressing the central venous pressure. Cardiac index may also improve with MCS support. Additional studies are needed to evaluate this concept for managing Fontan failure.

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In vitro measurement of hepatic flow distribution in Fontan vascular conduits: Towards rapid validation techniques

Cited by 3 publications

References 41 publications

In vitro hemodynamic performance of a blood pump for self-powered venous assist in univentricular hearts

In vitro hemodynamic performance of a blood pump for self-powered venous assist in univentricular hearts

In Vitro Hemodynamic Performance of a Blood Pump for Self-powered Venous Assist in Univentricular Hearts

In vitro investigation of axial mechanical support devices implanted in the novel convergent cavopulmonary connection Fontan

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