Technical feasibility and intermediate outcomes of using a handcrafted, area-preserving, bifurcated Y-graft modification of the Fontan procedure

Martin, Mary Hunt; Feinstein, Jeffrey A.; Chan, Frandics P.; Marsden, Alison L.; Yang, Weiguang; Reddy, V. Mohan

doi:10.1016/j.jtcvs.2014.08.058

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…Moreover, simulation-derived designs from SimVascular have been translated to clinical use, an example of which is the pilot study of the Fontan Y-graft. 34,37 …”

Section: Resultsmentioning

confidence: 99%

SimVascular: An Open Source Pipeline for Cardiovascular Simulation

et al. 2016

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Patient-specific cardiovascular simulation has become a paradigm in cardiovascular research and is emerging as a powerful tool in basic, translational and clinical research. In this paper we discuss the recent development of a fully open-source SimVascular software package, which provides a complete pipeline from medical image data segmentation to patient-specific blood flow simulation and analysis. This package serves as a research tool for cardiovascular modeling and simulation, and has contributed to numerous advances in personalized medicine, surgical planning and medical device design. The SimVascular software has recently been refactored and expanded to enhance functionality, usability, efficiency and accuracy of image-based patient-specific modeling tools. Moreover, SimVascular previously required several licensed components that hindered new user adoption and code management and our recent developments have replaced these commercial components to create a fully open source pipeline. These developments foster advances in cardiovascular modeling research, increased collaboration, standardization of methods, and a growing developer community.

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“…Moreover, simulation-derived designs from SimVascular have been translated to clinical use, an example of which is the pilot study of the Fontan Y-graft. 34,37 …”

Section: Resultsmentioning

confidence: 99%

SimVascular: An Open Source Pipeline for Cardiovascular Simulation

et al. 2016

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“…With regard to new technical options, Marsden et al tested a Y-shaped extra-cardiac Fontan baffle using a CFD model [25], and demonstrated the technical feasibility and intermediate outcomes of this modification in six patients [26]. Their results indicate that the procedure may be an option for high-risk patients (with discordant anatomy) during bilateral BCPS.…”

Section: Therapeutic Options and New Techniquesmentioning

confidence: 99%

Flow Dynamics of Bilateral Superior Cavopulomonary Shunts Influence Outcomes After Fontan Completion

et al. 2020

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Bilateral superior vena cava (SVC), which occurs following bilateral bidirectional cavopulmonary shunt (BCPS), is an anomaly marked by unique hemodynamics. This study aimed to determine its effects on outcomes after Fontan completion. Among 405 patients who underwent BCPS and total cavopulmonary connection (TCPC) between 1997 and 2017, 40 required a bilateral-BCPS. The dominant SVC prior to TCPC was identified according to the direction of blood flow in the central pulmonary artery, and its relationship to the inferior vena cava (IVC) was classified as a concordant or discordant relationship. Preoperative factors were analyzed to identify the risk factors for specific adverse outcomes. The length of intensive care unit (ICU) stay after TCPC was longer in the 40 patients who underwent bilateral-BCPS than in those who underwent unilateral BCPS (p = 0.024), and the survival rate was lower in the former group than in the latter group (p = 0.004). In the patients who underwent bilateral-BCPS, the dominant SVC was concordant with the IVC in 30 patients and discordant in 10 patients. With regard to whether certain morphological, hemodynamic, and flow dynamics-related variables were risk factors for adverse outcomes following TCPC, a discordant relationship between dominant SVC and IVC was identified as an independent risk factor for both a longer ICU stay (p = 0.037, HR 2.370) and worse survival (p = 0.019, HR 13.880). Therefore, in patients with a bilateral SVC who have previously undergone bilateral-BCPS, a discordant relationship between dominant SVC and IVC might contribute to worse outcomes following TCPC.

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“…Continual efforts are made to improve the surgical techniques used in Fontan surgery. Recently, a Y-shaped graft was proposed for the connection of the inferior vena cava to the left and right pulmonary artery 139 . Theoretically, this graft is more energetically favorable and provides better distribution of hepatic blood flow between the left and right pulmonary artery, distributing “hepatic factors” that may prevent the formation of intrapulmonary collaterals more equally.…”

Section: State Of the Artmentioning

confidence: 99%

State of the art of the Fontan strategy for treatment of univentricular heart disease

et al. 2018

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In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival. However, the resulting Fontan physiology is associated with high morbidity. In this review, we discuss the state of the art of the Fontan strategy by assessing survival and risk factors for mortality. Complications of the Fontan circulation, such as cardiac arrhythmia, thromboembolism, and protein-losing enteropathy, are discussed. Common surgical and catheter-based interventions following Fontan completion are outlined. We describe functional status measurements such as quality of life and developmental outcomes in the contemporary Fontan patient. The current role of drug therapy in the Fontan patient is explored. Furthermore, we assess the current use and outcomes of mechanical circulatory support in the Fontan circulation and novel surgical innovations. Despite large improvements in outcomes for contemporary Fontan patients, a large burden of disease exists in this patient population. Continued efforts to improve outcomes are warranted. Several remaining challenges in the Fontan field are outlined.

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Technical feasibility and intermediate outcomes of using a handcrafted, area-preserving, bifurcated Y-graft modification of the Fontan procedure

Cited by 24 publications

References 18 publications

SimVascular: An Open Source Pipeline for Cardiovascular Simulation

SimVascular: An Open Source Pipeline for Cardiovascular Simulation

Flow Dynamics of Bilateral Superior Cavopulomonary Shunts Influence Outcomes After Fontan Completion

State of the art of the Fontan strategy for treatment of univentricular heart disease

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