Role of surgeon intuition and computer-aided design in Fontan optimization: A computational fluid dynamics simulation study

Computational Fontan Analysis: Preserving accuracy while expediting workflow

“…Three types of solvers, including SIMPLE steady-state, coupled steady-state, and SIMPLE transient, were investigated by applying 0.5 mm, 0.7 mm and 1 mm mesh sizes to all models. Both the steady and transient flow equations formulated as follows were solved using time-averaged flow rates at the SVC and IVC inlets, and the percentages of total inflow at the LPA and RPA outlets (8). The BC of the Fontan models are presented in Table.…”

“…Predicting the best shape and implantation of the Fontan graft involves balancing several different, sometimes opposing goals, including but not limited to balancing HFD and reducing power loss (8,9). Computational fluid dynamics (CFD) simulation has been employed to explore different surgical options and to assist in predicting post-operative hemodynamic performance (10,11).…”

Commentary: Yet another Fontan computational study—but this one has clay

“…What does clay have to do with computational flow dynamics (CFD) and the personalized Fontan (herein referred to as the TCPC)? Loke and colleagues' response 1 is that a surgeonfashioned clay TCPC actually performed reasonably well and could reduce the computational time and money by serving as starting input for the CFD iterative process. With the availability of surgical modeling software, we don't fully understand the need for clay and haptic feedback but, must admit, find the use of clay kind of appealing-can't explain it, maybe it invokes pleasant childhood memories.…”

“…The data are then entered into a first-stage software program that builds an extracardiac Fontan circuit using computational fluid dynamics with full fluid-structure interaction (Figure 1). 1 The model incorporates a totally implantable Fontan assist mechanism. The model anatomy is adjusted in 500 iterations, using artificial intelligence to optimize approximately 50 hemodynamic characteristics under conditions of rest, exercise, and growth.…”

Commentary: Man versus machine: Whose side are you on?

“…2 Devastated and saddened by his defeat, Se-dol retired from professional play stating, ''Even if I become the number one, there is an entity that cannot be defeated.'' 3 In an effort to customize the Fontan procedure for optimal flow and hemodynamics, Lok and colleagues 4 have pitted human surgeons against the machine. The authors demonstrate that an extracardiac Fontan conduit recreated based on surgeon's intuition achieved lower power loss than one produced by computer-aided design (CAD).…”