Progress of Cavopulmonary Assisting Device for Fontan Circulation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUANHai-yun , CHENJi-mei ,  ZHUANGJian

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, P. R. China;

Corresponding author：

ZHUANGJian, Email: drzhuangjian5413@163.com

Keywords：

Congenital heart defect; Fontan procedure; Heart-assisted devices

DOI：

10.7507/1007-4848.20160174

Video：

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While the Fontan operation has improved the survival of a generation of children born with a functional single ventricle, it does not recreate a normal circulation. However, significant challenges remain. Early stage mortality risk seems stubbornly high. The risk of late cowplications seriously affect the longterm survival of children. As new techniques and therapies exist, more single ventricle patients survive till adulthood. Therefore, the limits of Fontan procedures is more and more evident. In recent years, the study of mechanical cavopulmonary assisting device, which addresses the limitations of Fontan circulation, has been developed and provided a more stable and effective biventricular of blood flow in the total cavopulmonary connection in existence. This would benefit not only the treatment of late Fontan complications, but also facilitating early surgical repair, which is promising.

Citation： YUANHai-yun, CHENJi-mei, ZHUANGJian. Progress of Cavopulmonary Assisting Device for Fontan Circulation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 728-731. doi: 10.7507/1007-4848.20160174 Copy

1.	Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax, 1971, 26(3):240-248.
2.	Kreutzer G, Galindez E, Bono H, et al. An operation for the correc-tion of tricuspid atresia. J Thorac Cardiovasc Surg, 1973, 66(4):613-621.
3.	de Leval MR. The Fontan circulation:What have we learned? What to expect? Pediatr Cardiol, 1998, 19(4):316-320.
4.	de Leval MR, Kilner P, Gewillig M, et al. Total cavopulmonary connection:a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988, 96(5):682-695.
5.	d'Udekem Y, Iyengar AJ, Cochrane AD, et al. The Fontan procedure:contemporary techniques have improved long-term outcomes. Circulation, 2007, 116(11 Suppl):I157-1164.
6.	Khairy P, Poirier N, Mercier LA. Univentricular heart. Circulation, 2007, 115(6):800-812.
7.	Restrepo M, Tang E, Haggerty CM, et al. Energetic implications of vessel growth and flow changes over time in Fontan patients. Ann Thorac Surg, 2015, 99(1):163-170.
8.	Kansy A, Brzezinska-Rajszys G, Zubrzycka M, et al. Pulmonary artery growth in univentricular physiology patients. Kardiologia polska, 2013, 71(6):581-587.
9.	Haggerty CM, Whitehead KK, Bethel J, et al. Relationship of single ventricle filling and preload to total cavopulmonary connection hemodynamics. Ann Thorac Surg, 2015, 99(3):911-917.
10.	Isoda S, Thomas GA, Nakajima H, et al. Skeletal muscle ventricles:Frontiers in 1995. Artif Organs, 1996, 20(2):114-119.
11.	Hoganson DM, Boston US, Gazit AZ, et al. Successful bridge through transplantation with berlin heart ventricular assist device in a child with failing fontan. Ann Thorac Surg, 2015, 99(2):707-709.
12.	Kerlo AEM, Delorme YT, Xu D, et al. Experimental characterization of powered Fontan hemodynamics in an idealized total cavopul-monary connection model. Exper Fluids, 2013, 54(8):18.
13.	Zhu J, Kato H, Fu YY, et al. Cavopulmonary support with a microa-xial pump for the failing Fontan physiology. Asaio J, 2015, 61(1):49-54.
14.	Nuland SB, Glenn WW, Guilfoil PH. Circulatory bypass of the right heart. III. Some observations on long-term survivors. Surgery, 1958, 43(2):184-201.
15.	Rodefeld MD, Boyd JH, Myers CD, et al. Cavopulmonary assist in the neonate:an alternative strategy for single-ventricle palliation. J Thorac Cardiovasc Surg, 2004, 127(3):705-711.
16.	Giridharan GA, Koenig SC, Kennington J, et al. Performance eval-uation of a pediatric viscous impeller pump for Fontan cavopulmo-nary assist. J Thorac Cardiovasc Surg, 2013, 145(1):249-257.
17.	Delorme Y, Anupindi K, Kerlo AE, et al. Large eddy simulation of powered Fontan hemodynamics. J Biomech, 2013, 46(2):408-422.
18.	Niebler RA, Ghanayem NS, Shah TK, et al. Use of a heartware ventricular assist device in a patient with failed Fontan circulation. Ann Thorac Surg, 2014, 97(4):e115-116.
19.	Ricci M, Gaughan CB, Rossi M, et al. Initial experience with the TandemHeart circulatory support system in children. Asaio J, 2008, 54(5):542-545.
20.	Mackling T, Shah T, Dimas V, et al. Management of single ventricle patients with Berlin Heart EXCOR ventricular assist device:Single center experience. Artif Organs, 2012, 36(6):555-559.
21.	Kaestner M, Seitz S, Buchholz H, et al. Right ventricular assist device as a bridge to recovery postheart transplantation for failed Fontan circulation. Thorac Cardiov Surg, 2013, 61(S02):57.
22.	Valdovinos J, Shkolyar E, Carman GP, et al. In vitro evaluation of an external compression device for fontan mechanical assistance. Artif Organs, 2014, 38(3):199-207.
23.	Yamada A, Shiraishi Y, Miura H, et al. Development of a thermo-dynamic control system for the Fontan circulation pulsation device using shape memoryalloy fibers. J Artif Organs, 2015, 18(3):199-205.
24.	Rodefeld MD, Boyd JH, Myers CD, et al. Cavopulmonary assist:circulatory support for the univentricular Fontan circulation. Ann Thorac Surg, 2003, 76(6):1911-1916.
25.	Boni L, Sasaki T, Ferrier WT, et al. Challenges in longer-term mechanical support of fontan circulation in sheep. Asaio J, 2012, 58(1):60-64.
26.	Haggerty CM, Fynn-Thompson F, McElhinney DB, et al. Experi-mental and numeric investigation of Impella pumps as cavopul-monary assistance for a failing Fontan. J Thorac Cardiovasc Surg, 2012, 144(3):563-569.
27.	Tahir SA, Moskowitz WB, Throckmorton AL. Numerical analysis of protective cage geometries for mechancical cavopulmonary assistance in a patient-specific fontan physiology. J Med Biol Eng, 2013, 33(3):257-262.
28.	Guyton RA, Davis SC, Michalik RE, et al. Right heart assist by intermittent abdominal compression after surgery for congenital heart disease. Circulation, 1985, 72(3 Pt 2):II97-100.
29.	Milliken JC, Laks H, George B. Use of a venous assist device after repair of complex lesions of the right heart. J Am Coll Cardiol, 1986, 8(4):922-929.
30.	Jacobs ML, Vlahakes GJ, D'Ambra MN, et al. Augmentation of pulmonary blood flow by a right atrial balloon pump after the Fontan operation. Circulation, 1987, 76(3 Pt 2):III72-76.
31.	Kilner PJ. Valveless pump models that laid a false but fortuitous trail on the way towards the total cavopulmonary connection. Cardiol Young, 2005, 15(SUPPL 3):74-79.
32.	Kocyildirim E, Dur O, Soran O, et al. Pulsatile venous waveform quality in Fontan circulation-clinical implications, venous assists options and the future. Anadolu Kardiyol Derg, 2012, 12(5):420-426.
33.	Esmaily-Moghadam M, Hsia TY, Marsden AL, et al. The assisted bidirectional Glenn:a novel surgical approach for first-stage single-ventricle heart palliation. J Thorac Cardiovasc Surg, 2015, 149(3):699-705.
34.	Pekkan K, Frakes D, De Zelicourt D, et al. Coupling pediatric ventricle assist devices to the Fontan circulation:simulations with a lumped-parameter model. Asaio J, 2005, 51(5):618-628.
35.	Dur O, Lara M, Arnold D, et al. Pulsatile in vitro simulation of the pediatric univentricular circulation for evaluation of cardiopul-monary assist scenarios. Artif Organs, 2009, 33(11):967-976.
36.	Chopski SG, Downs E, Haggerty CM, et al. Laser flow measurements in an idealized total cavopulmonary connection with mechanical circulatory assistance. Artif Organs, 2011, 35(11):1052-1064.
37.	Chopski SG, Rangus OM, Downs EA, et al. Three-dimensional laser flow measurements of a patient-specific fontan physiology with mechanical circulatory assistance. Artif Organs, 2015, 39(6):E67-78.
38.	Durham LA 3rd, Dearani JA, Burkhart HM, et al. Application of computer modeling in systemic VAD support of failing Fontan physiology. World J Pediatr Congenit Heart Surg, 2011, 2(2):243-248.
39.	Throckmorton AL, Kapadia JY, Chopski SG, et al. Numerical, hydraulic, and hemolytic evaluation of an intravascular axial flow blood pump to mechanically support Fontan patients. Ann Biomed Eng, 2011, 39(1):324-336.
40.	Iliff B, Kerlo A, Chen J, et al. In vitro ultrasound measurements of powered and unpowered total cavopulmonary connection. Austin J Biomed Eng, 2014, 1(6):1026.
41.	Di Molfetta A, Amodeo A, Fresiello L, et al. Simulation of ventri-cular, cavo-pulmonary, and biventricular ventricular assist devices in failing Fontan. Artif Organs, 2015, 39(7):550-558.
42.	Chachques JC, Grandjean P, Serraf A, et al. Atrial cardiomyoplasty after Fontan-type procedures. Circulation, 1990, 82(5 Suppl):Ⅳ183-189.
43.	Rossano JW, Woods RK, Berger S, et al. Mechanical support as fail-ure intervention in patients with cavopulmonary shunts (MFICS):rationale and aims of a new registry of mechanical circulatory support in single ventricle patients. Congenit Heart Dis, 2013, 8(3):182-186.

1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax, 1971, 26(3):240-248.
2. Kreutzer G, Galindez E, Bono H, et al. An operation for the correc-tion of tricuspid atresia. J Thorac Cardiovasc Surg, 1973, 66(4):613-621.
3. de Leval MR. The Fontan circulation:What have we learned? What to expect? Pediatr Cardiol, 1998, 19(4):316-320.
4. de Leval MR, Kilner P, Gewillig M, et al. Total cavopulmonary connection:a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988, 96(5):682-695.
5. d'Udekem Y, Iyengar AJ, Cochrane AD, et al. The Fontan procedure:contemporary techniques have improved long-term outcomes. Circulation, 2007, 116(11 Suppl):I157-1164.
6. Khairy P, Poirier N, Mercier LA. Univentricular heart. Circulation, 2007, 115(6):800-812.
7. Restrepo M, Tang E, Haggerty CM, et al. Energetic implications of vessel growth and flow changes over time in Fontan patients. Ann Thorac Surg, 2015, 99(1):163-170.
8. Kansy A, Brzezinska-Rajszys G, Zubrzycka M, et al. Pulmonary artery growth in univentricular physiology patients. Kardiologia polska, 2013, 71(6):581-587.
9. Haggerty CM, Whitehead KK, Bethel J, et al. Relationship of single ventricle filling and preload to total cavopulmonary connection hemodynamics. Ann Thorac Surg, 2015, 99(3):911-917.
10. Isoda S, Thomas GA, Nakajima H, et al. Skeletal muscle ventricles:Frontiers in 1995. Artif Organs, 1996, 20(2):114-119.
11. Hoganson DM, Boston US, Gazit AZ, et al. Successful bridge through transplantation with berlin heart ventricular assist device in a child with failing fontan. Ann Thorac Surg, 2015, 99(2):707-709.
12. Kerlo AEM, Delorme YT, Xu D, et al. Experimental characterization of powered Fontan hemodynamics in an idealized total cavopul-monary connection model. Exper Fluids, 2013, 54(8):18.
13. Zhu J, Kato H, Fu YY, et al. Cavopulmonary support with a microa-xial pump for the failing Fontan physiology. Asaio J, 2015, 61(1):49-54.
14. Nuland SB, Glenn WW, Guilfoil PH. Circulatory bypass of the right heart. III. Some observations on long-term survivors. Surgery, 1958, 43(2):184-201.
15. Rodefeld MD, Boyd JH, Myers CD, et al. Cavopulmonary assist in the neonate:an alternative strategy for single-ventricle palliation. J Thorac Cardiovasc Surg, 2004, 127(3):705-711.
16. Giridharan GA, Koenig SC, Kennington J, et al. Performance eval-uation of a pediatric viscous impeller pump for Fontan cavopulmo-nary assist. J Thorac Cardiovasc Surg, 2013, 145(1):249-257.
17. Delorme Y, Anupindi K, Kerlo AE, et al. Large eddy simulation of powered Fontan hemodynamics. J Biomech, 2013, 46(2):408-422.
18. Niebler RA, Ghanayem NS, Shah TK, et al. Use of a heartware ventricular assist device in a patient with failed Fontan circulation. Ann Thorac Surg, 2014, 97(4):e115-116.
19. Ricci M, Gaughan CB, Rossi M, et al. Initial experience with the TandemHeart circulatory support system in children. Asaio J, 2008, 54(5):542-545.
20. Mackling T, Shah T, Dimas V, et al. Management of single ventricle patients with Berlin Heart EXCOR ventricular assist device:Single center experience. Artif Organs, 2012, 36(6):555-559.
21. Kaestner M, Seitz S, Buchholz H, et al. Right ventricular assist device as a bridge to recovery postheart transplantation for failed Fontan circulation. Thorac Cardiov Surg, 2013, 61(S02):57.
22. Valdovinos J, Shkolyar E, Carman GP, et al. In vitro evaluation of an external compression device for fontan mechanical assistance. Artif Organs, 2014, 38(3):199-207.
23. Yamada A, Shiraishi Y, Miura H, et al. Development of a thermo-dynamic control system for the Fontan circulation pulsation device using shape memoryalloy fibers. J Artif Organs, 2015, 18(3):199-205.
24. Rodefeld MD, Boyd JH, Myers CD, et al. Cavopulmonary assist:circulatory support for the univentricular Fontan circulation. Ann Thorac Surg, 2003, 76(6):1911-1916.
25. Boni L, Sasaki T, Ferrier WT, et al. Challenges in longer-term mechanical support of fontan circulation in sheep. Asaio J, 2012, 58(1):60-64.
26. Haggerty CM, Fynn-Thompson F, McElhinney DB, et al. Experi-mental and numeric investigation of Impella pumps as cavopul-monary assistance for a failing Fontan. J Thorac Cardiovasc Surg, 2012, 144(3):563-569.
27. Tahir SA, Moskowitz WB, Throckmorton AL. Numerical analysis of protective cage geometries for mechancical cavopulmonary assistance in a patient-specific fontan physiology. J Med Biol Eng, 2013, 33(3):257-262.
28. Guyton RA, Davis SC, Michalik RE, et al. Right heart assist by intermittent abdominal compression after surgery for congenital heart disease. Circulation, 1985, 72(3 Pt 2):II97-100.
29. Milliken JC, Laks H, George B. Use of a venous assist device after repair of complex lesions of the right heart. J Am Coll Cardiol, 1986, 8(4):922-929.
30. Jacobs ML, Vlahakes GJ, D'Ambra MN, et al. Augmentation of pulmonary blood flow by a right atrial balloon pump after the Fontan operation. Circulation, 1987, 76(3 Pt 2):III72-76.
31. Kilner PJ. Valveless pump models that laid a false but fortuitous trail on the way towards the total cavopulmonary connection. Cardiol Young, 2005, 15(SUPPL 3):74-79.
32. Kocyildirim E, Dur O, Soran O, et al. Pulsatile venous waveform quality in Fontan circulation-clinical implications, venous assists options and the future. Anadolu Kardiyol Derg, 2012, 12(5):420-426.
33. Esmaily-Moghadam M, Hsia TY, Marsden AL, et al. The assisted bidirectional Glenn:a novel surgical approach for first-stage single-ventricle heart palliation. J Thorac Cardiovasc Surg, 2015, 149(3):699-705.
34. Pekkan K, Frakes D, De Zelicourt D, et al. Coupling pediatric ventricle assist devices to the Fontan circulation:simulations with a lumped-parameter model. Asaio J, 2005, 51(5):618-628.
35. Dur O, Lara M, Arnold D, et al. Pulsatile in vitro simulation of the pediatric univentricular circulation for evaluation of cardiopul-monary assist scenarios. Artif Organs, 2009, 33(11):967-976.
36. Chopski SG, Downs E, Haggerty CM, et al. Laser flow measurements in an idealized total cavopulmonary connection with mechanical circulatory assistance. Artif Organs, 2011, 35(11):1052-1064.
37. Chopski SG, Rangus OM, Downs EA, et al. Three-dimensional laser flow measurements of a patient-specific fontan physiology with mechanical circulatory assistance. Artif Organs, 2015, 39(6):E67-78.
38. Durham LA 3rd, Dearani JA, Burkhart HM, et al. Application of computer modeling in systemic VAD support of failing Fontan physiology. World J Pediatr Congenit Heart Surg, 2011, 2(2):243-248.
39. Throckmorton AL, Kapadia JY, Chopski SG, et al. Numerical, hydraulic, and hemolytic evaluation of an intravascular axial flow blood pump to mechanically support Fontan patients. Ann Biomed Eng, 2011, 39(1):324-336.
40. Iliff B, Kerlo A, Chen J, et al. In vitro ultrasound measurements of powered and unpowered total cavopulmonary connection. Austin J Biomed Eng, 2014, 1(6):1026.
41. Di Molfetta A, Amodeo A, Fresiello L, et al. Simulation of ventri-cular, cavo-pulmonary, and biventricular ventricular assist devices in failing Fontan. Artif Organs, 2015, 39(7):550-558.
42. Chachques JC, Grandjean P, Serraf A, et al. Atrial cardiomyoplasty after Fontan-type procedures. Circulation, 1990, 82(5 Suppl):Ⅳ183-189.
43. Rossano JW, Woods RK, Berger S, et al. Mechanical support as fail-ure intervention in patients with cavopulmonary shunts (MFICS):rationale and aims of a new registry of mechanical circulatory support in single ventricle patients. Congenit Heart Dis, 2013, 8(3):182-186.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress of Cavopulmonary Assisting Device for Fontan Circulation

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