Target Flow-Pressure Operating Range for Designing a Failing Fontan Cavopulmonary Support Device

Farahmand, Masoud; Kavarana, Minoo N.; Trusty, Phillip M.; Kung, Ethan

doi:10.1109/tbme.2020.2974098

Cited by 4 publications

(1 citation statement)

References 37 publications

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“…A total of 10 trials [5][6][7][8][9][10][11][12][13][14] were identified which fulfilled the inclusion criteria as well as the needed outcome parameters; while another 10 trials were excluded due to unmet outcomes [15][16][17][18][19][20][21][22]. Some of the included trials involved different settings in terms of pump speed or terms of device design, a total of 23 sets of adjustments were finally analyzed in terms of their impact on IVC and SVC pressure and resultant flow rate.…”

Section: Resultsmentioning

confidence: 99%

Fontan Assist Devices, a Systematic Review of Twenty Years of Experimental and In Vivo Trials

AbdelMassih,

Allami,

AlTatari

et al. 2024

Preprint

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Background:Fontan completion is the last stage of univentricular repair, which drains the inferior vena cava against gravity to a higher-pressure pulmonary arterial circulation. The passivity and anti-gravity nature of this circulation render a failing Fontan, not an uncommon encounter, twenty years ago, Rodefeld and colleagues, decided to explore the feasibility of vascular pumps to support the passive nature of Fontan circulation, and since then, trials are still ongoing, and we aimed through this review to wrap up the results of these trials. Methods:A literature review has been conducted, to identify any in vivo or in vitro trial of a Fontan assist device. Several outcome parameters determined whether the trial will be included or not in this review, including, the flow rate of a pump if applicable, the number of compressions per minute if a compression device has been used, the resultant flow rate, the inferior and superior vena cava pressures, associated with each setting of the respective device, and any evidence of hemolysis or clotting within the circuit. Results:A total of ten trials have been included, with 23 different settings. Three designs have been identified, out of which two fall within the pump design, namely the connecting chamber and the intravascular pump designs; only one trial explored the possible use of a compression device. The commonest design encountered in in-vivo trials was the intravascular pump (67%). No reports of significant hemolysis or thrombosis were found. An increasing flow rate beyond 5L/min was associated with a negative outcome in the connecting chamber design, increasing upstream pressure in the SVC, while intravascular pumps did not display this limitation. Conclusion:Univentricular heart patients are a relatively small population, with very extensive needs, despite twenty years of trials, no study has yet concluded the optimal design or settings for a Fontan assist device. In this review, we identified that the intravascular pump remains the most practical design, due to its easy mode of insertion, and that it is not faced with the limitation or risk of increasing upstream resistance. There is still a long way to conclude its use as other designs such as compression devices have not yet been fully studied.

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