title: Surgical planning of the total cavopulmonary connection: robustness analysis.
abstract: In surgical planning of the Fontan connection for single ventricle physiologies, there can be differences between the proposed and implemented options. Here, we developed a surgical planning framework that help determine the best performing option and ensures that the results will be comparable if there are slight geometrical variations. Eight patients with different underlying anatomies were evaluated in this study; surgical variations were created for each connection by changing either angle, offset or baffle diameter. Computational fluid dynamics were performed and the energy efficiency (indexed power loss-iPL) and hepatic flow distribution (HFD) computed. Differences with the original connection were evaluated: iPL was not considerably affected by the changes in geometry. For HFD, the single superior vena cava (SVC) connections presented less variability compared to the other anatomies. The Y-graft connection was the most robust overall, while the extra-cardiac connections showed dependency to offset. Bilateral SVC and interrupted inferior vena cava with azygous continuation showed high variability in HFD. We have developed a framework to assess the robustness of a surgical option for the TCPC; this will be useful to assess the most complex cases where pre-surgery planning could be most beneficial to ensure an efficient and robust hemodynamic performance.
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Restrepo
authors.forename: Mark
authors.initials: M
authors.lastname: Luffel
authors.forename: Jake
authors.initials: J
authors.lastname: Sebring
authors.forename: Kirk
authors.initials: K
authors.lastname: Kanter
authors.forename: Pedro
authors.initials: P
authors.lastname: Del Nido
authors.forename: Alessandro
authors.initials: A
authors.lastname: Veneziani
authors.forename: Jarek
authors.initials: J
authors.lastname: Rossignac
authors.forename: Ajit
authors.initials: A
authors.lastname: Yoganathan
mesh_terms: D003198:Computer Simulation; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D010934:Planning Techniques