Surgical Planning of the Total Cavopulmonary Connection: Robustness Analysis

Restrepo, Maria; Luffel, Mark; Sebring, Jake; Kanter, Kirk R.; Nido, Pedro J. del; Veneziani, Alessandro; Rossignac, Jarek; Yoganathan, Ajit P.

doi:10.1007/s10439-014-1149-7

Cited by 21 publications

(19 citation statements)

References 32 publications

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“…It is noted that, although 50% HFD is assumed to be optimal for many previous studies (Haggerty et al, 2014; Sundareswaran et al, 2009a; Yang et al, 2013), the exact value required for preventing or alleviating PAVMs is still unknown. Clinically acceptable HFD ranges from 30% to 70% (Haggerty et al, 2012; Restrepo et al, 2015a, 2015b; Sundareswaran et al, 2009a; Trusty et al, 2016). Therefore, a 7.8% discrepancy in HFD between using the time-averaged and pulsatile BCs may not significantly affect clinical decisions based upon HFD.…”

Section: Discussionmentioning

confidence: 99%

“…In single ventricle lesions, especially at the Fontan stage, numerical simulations have been used to understand patient hemodynamics (Khiabani et al, 2015; Marsden et al, 2007; Tang et al, 2014), test novel treatment concepts (Esmaily-Moghadam et al, 2015; Trusty et al, 2016; Yang et al, 2013), and predict surgical outcomes (de Zélicourt et al, 2011; de Zélicourt and Kurtcuoglu, 2015; Haggerty et al, 2012; Kung et al, 2013; Sundareswaran et al, 2009a). Cardiovascular simulation has become a fruitful area of translational research and has potential to impact clinical decisions, especially by assisting surgical planning (de Zélicourt and Kurtcuoglu, 2015; Fogel et al, 2013; Marsden and Esmaily-Moghadam, 2015; Marsden, 2014; Restrepo et al, 2015b). Figure 1 illustrates a standard procedure of the surgical planning for congenital single ventricle heart diseases.…”

Section: Introductionmentioning

confidence: 99%

“…A geometric robustness analysis was also developed to assess the discrepancy in surgical planning outcomes between the proposed and implemented anatomies (Restrepo et al, 2015b). However, numerous challenges limit the effectiveness and applicability of surgical planning.…”

Section: Introductionmentioning

confidence: 99%

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Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning?

Wei

Trusty

Tree

et al. 2017

Journal of Biomechanics

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Cardiovascular simulations have great potential as a clinical tool for planning and evaluating patient-specific treatment strategies for those suffering from congenital heart diseases, specifically Fontan patients. However, several bottlenecks have delayed wider deployment of the simulations for clinical use; the main obstacle is simulation cost. Currently, time-averaged clinical flow measurements are utilized as numerical boundary conditions (BCs) in order to reduce the computational power and time needed to offer surgical planning within a clinical time frame. Nevertheless, pulsatile blood flow is observed in vivo, and its significant impact on numerical simulations has been demonstrated. Therefore, it is imperative to carry out a comprehensive study analyzing the sensitivity of using time-averaged BCs. In this study, sensitivity is evaluated based on the discrepancies between hemodynamic metrics calculated using time-averaged and pulsatile BCs; smaller discrepancies indicate less sensitivity. The current study incorporates a comparison between 3D patient-specific CFD simulations using both the time-averaged and pulsatile BCs for 101 Fontan patients. The sensitivity analysis involves two clinically important hemodynamic metrics: hepatic flow distribution (HFD) and indexed power loss (iPL). Paired demographic group comparisons revealed that HFD sensitivity is significantly different between single and bilateral superior vena cava cohorts but no other demographic discrepancies were observed for HFD or iPL. Multivariate regression analyses show that the best predictors for sensitivity involve flow pulsatilities, time-averaged flow rates, and geometric characteristics of the Fontan connection. These predictors provide patient-specific guidelines to determine the effectiveness of analyzing patient-specific surgical options with time-averaged BCs within a clinical time frame.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning?

Wei

Trusty

Tree

et al. 2017

Journal of Biomechanics

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“…Along the same lines, Restrepo et al 33 assessed the sensitivity of the different performance metrics (HFD and PL) to prescribed geometrical deviations and from there derived an additional ''robustness'' parameter for the optimization. Similar approaches could be used to probe the sensitivity to all input parameters, notably inflow conditions.…”

Section: Clinical Validation and Uncertainty Quantificationmentioning

confidence: 99%

Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure

Zélicourt

Kurtcuoglu

2015

Ann Biomed Eng

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The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework.

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“…Several studies performed computational fluid dynamics (CFD) and aimed to achieve an ideal cavopulmonary connection 13,14 . A Venturi jet was designed to assist bidirectional Glenn in a previous study, but the increases in pulmonary flow were generally accompanied by increases in superior vena cava (SVC) pressure 15,16 .…”

mentioning

confidence: 99%

Hemodynamic Effects of A Simplified Venturi Conduit for Fontan Circulation: A Pilot, In Silico Analysis

Zhu

Shi

Wen

et al. 2020

Sci Rep

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Objectives: To study the effects of a self-powered Fontan circulation in both idealized Fontan models and patient-specific models. Methods: In silico, a conduit with a nozzle was introduced from ascending aorta into the anastomosis of superior vena cava and pulmonary artery. Computational fluid dynamics (CFD) simulation was applied to calculate the fluid fields of models. Three 3-dimentional idealized models with different offsets were reconstructed by computer-aided design to evaluate the effects of the self-powered conduit. Furthermore, to validate the effects in patient-specific models, the conduit was introduced to three reconstructed models with different offsets. Results: The pressures at superior venae cavae and inferior venae cavae were decreased in both idealized models (0.4 mmHg) and patientspecific models (0.7 mmHg). In idealized models, the flows to left lungs were decreased (70%) by the jets from the conduits. However, in patient-specific models, the reductions of blood to the left lungs were relatively limited (30%) comparing to idealized models. Conclusions: CFD simulation was applied to analyze the effectiveness of the Fontan self-powered conduit. This self-powered conduit may help to decrease the venae cavae pressures and increase the flow to pulmonary arteries.

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Surgical Planning of the Total Cavopulmonary Connection: Robustness Analysis

Cited by 21 publications

References 32 publications

Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning?

Can time-averaged flow boundary conditions be used to meet the clinical timeline for Fontan surgical planning?

Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure

Hemodynamic Effects of A Simplified Venturi Conduit for Fontan Circulation: A Pilot, In Silico Analysis

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