Progress in experimental and clinical subpulmonary assistance for Fontan circulation

Abstract

Experimental subpulmonary assist device for Fontan circulation: von Karman impeller pump. Central Message Patients with Fontan circulation experience sequelae related to chronic attrition from altered hemodynamics; a subpulmonary assist device may improve cardiovascular status and alleviate symptoms. Perspective Investigators have formulated creative solutions to address the unmet need for subpulmonary Fontan circulation assistance, but substantial clinical translation has not been realized. In this article, we review experimental and clinical attempts for cavopulmonary assistance in patients with single ventricles and highlight promising strategies to create a subpulmonary assist device for the Fontan circulation.

Commentary: Mechanical support for the subpulmonary circulation of Fontan physiology—A step in the right direction

“…2 In the hopes of ''normalizing'' the circulation, much effort has been expended to develop a method to reverse the ''pumpless'' subpulmonary hemodynamics. 3 A novel support system reported by Lin and colleagues 4 in this issue of the Journal is one such example. In their avant-garde concept, a percutaneously inserted multilumen cannula is coupled to a pump for subpulmonary assistance.…”

“…Although no such ideal device currently exists, promising technologic advances may one day achieve this goal. 3 The report from Lin and colleagues 4 demonstrates the need for ingenuity to progress the care of patients with a failing Fontan circulation. As has been repeatedly shown in medical history, it is this innovative spirit that brings about paradigm shifts in patient care.…”

Commentary: Fontan assist device support: Road map to “stage 4” palliation

“…Several groups endeavor to create an MCS approach to assist the subpulmonary circulation in patients undergoing the Fontan, with the intent to reverse the ''Fontan paradox.'' 3,4 To this end, Trusty and colleagues 5 present an impressive work demonstrating the potential for subpulmonary support using commercially available, extracorporeal centrifugal continuous-flow devices. The group tested the PediMag and CentriMag (Abbott Inc, Plymouth, Minn) for a subpulmonary circulatory support scenario in a mock circulation loop representative of single ventricle heart disease with a failing Fontan circulation.…”

Failing Fontan assist: From tissue to turbine

“…[3][4][5] Despite the significant challenges and constant effort, the search for ideal fourthstage management of single-ventricle palliation continues. 6 In this issue of the Journal, the excellent report by Broda and collagues 7 offers an overview of potential treatment options to support a failing Fontan circulation, extending from tissue-engineered products to turbine devices, some of which have already been used in the clinical setting. Broda and collagues 7 are to be congratulated on their clear and comprehensive description of support options in patients with a failing Fontan circulation.…”

“…The use of available mechanical ventricular assist devices in patients with a failing Fontan circulation in the low-pressure passive venous circulation is suboptimal. Despite the challenges with each of these models mentioned by Broda and colleagues, 7 moving forward with philosophical skepticism, these novel approaches may offer a way to improve the outcome for patients with Fontan failure physiology in the future. A prime example of an in vitro model of turbine pump is the feasibility study of an integrated aortic turbine venous-assist system in a mock Fontan circuit presented recently in the Journal by Pekkan and colleagues.…”