title: Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure.
abstract: The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework.
authors.affiliation: The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland. diane.dezelicourt@physiol.uzh.ch.
authors.forename: Diane A
authors.initials: DA
authors.lastname: de Zélicourt
authors.affiliation: The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.|Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.|National Center of Competence 'Kidney.CH', Zurich, Switzerland.
authors.forename: Vartan
authors.initials: V
authors.lastname: Kurtcuoglu
mesh_terms: D003198:Computer Simulation; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D057285:Precision Medicine / Q000379:methods*
keywords: Boundary conditions; Computational fluid dynamics (CFD); Multi-scale; Numerical simulations; Review; Single ventricle heart defects; Total cavopulmonary connection (TCPC)