Computational modeling of a right-sided Fontan assist device: Effectiveness across patient anatomies and cannulations

• Published in: Journal of biomechanics Vol. 109; p. 109917
• Main Authors: Trusty, Phillip M., Alan Wei, Zhenglun, Fogel, Mark A., Maher, Kevin, Deshpande, Shriprasad R., Yoganathan, Ajit P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 26.08.2020; Elsevier Limited
• Subjects: Animal models; Arteries; Blood vessels; Boundary conditions; Catheterization; Computer applications; Computer simulation; Data analysis; Electric power distribution; Flow distribution; Flow velocity; Fontan; Fontan Procedure; Heart Defects, Congenital; Heart function; Heart surgery; Heart-Assist Devices; Hemodynamics; Humans; Life expectancy; Life span; Liver; Lungs; Measurement techniques; Mechanical circulatory support; Model matching; Models, Cardiovascular; Patients; Pressure; Pulmonary arteries; Pulmonary artery; Right-sided support; Shear flow; Shear stress; Single ventricle; Stress concentration; Veins & arteries; Ventricular assist device; Wall shear stresses; Single ventricle; Right-sided support; Mechanical circulatory support; Ventricular assist device; Fontan
• ISSN: 0021-9290; 1873-2380
• DOI: 10.1016/j.jbiomech.2020.109917

The use of mechanical circulatory support for failing Fontan patients is an area of growing interest, as the increased life expectancy of these patients continues to be accompanied by numerous end-organ complications. In vitro work has shown positive results using the CentriMag device for right-sided Fontan support, however the generalizability across various patient anatomies and cannulations is unknown. Computational simulations are first validated against in vitro modeling, then used to assess generalizability and further explore hemodynamic metrics including relative pressure changes, hepatic flow distribution, wall shear stress and power added. Computational modeling matched previous in vitro work very well, with vessel flow rates and relative average pressure change each within 1%. Positive results were seen across all patient anatomies and cannulations. On average, pressure from the vena cava to pulmonary arteries increased by 5.4 mmHg corresponding to 32 mW of power added. Hepatic flow distribution and wall shear stress were within acceptable ranges, with an average hepatic flow distribution of 47% and all patients showing ≤ 1% of the total Fontan connection surface area at a wall shear stress above 150 Pa. The positive results previously seen using CentriMag as a right-sided Fontan support device were found to be repeatable across multiple patient anatomies and cannulations. While animal models and eventual patient studies will provide further insight into the efficacy of this support strategy, our findings here suggest this method may reproduce right heart function.