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A novel fontan Y-graft for interrupted inferior vena cava and azygos continuation
- Source :
- Interactive Cardiovascular and Thoracic Surgery
- Publication Year :
- 2022
- Publisher :
- Elsevier Science, 2022.
-
Abstract
- Objectives: to evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. Methods: for 9 patients, aged 2 to 18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. Results: the proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. Conclusions: the new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development.<br />European Union (EU); Horizon 2020; European Research Council (ERC); Proof of Concept Grant; BloodTurbine; ERC Starting Grant; Scientific and Technological Research Council of Turkey (TÜBİTAK); 1003 Priority-Research Program Grant
- Subjects :
- Pulmonary and Respiratory Medicine
Heart Defects, Congenital
Intratrial
Y-Graft
1004 Medical Biotechnology
Respiratory System
Hemodynamics
Single Ventricle
1103 Clinical Sciences
Vena Cava, Inferior
Computational Fluid Dynamics
Pulmonary Artery
Extracardiac
Fontan Procedure
Total Cavopulmonary Connection
Cardiac and cardiovascular systems
Respiratory system
Surgery
Patient-Specific Analysis
Pre-Surgical Planning
Humans
Total cavopulmonary connection
Computational fluid dynamics
Y-graft
Fontan procedure
Pre-surgical planning
Single ventricle
Patient-specific analysis
Cardiology and Cardiovascular Medicine
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Interactive Cardiovascular and Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....809e2ba91a57d5377470f7dfe5b1c998