title: The use of a numerical model to simulate the cavo-pulmonary assistance in Fontan circulation: a preliminary verification.
abstract: The lack of an established experience on the use of VAD for the cavo-pulmonary assistance leads to the need of dedicated VADs development and animal experiments. A dedicated numerical model could support clinical and experimental strategies design and new VADs testing. The aim of this work is to perform a preliminary verification of a lumped parameter model of the cardiovascular system to simulate Fontan physiology and the effect of cavo-pulmonary assistance. Literature data of 4 pigs were used to simulate animals' baseline, and then the model was tested in simulating Fontan circulation and cavo-pulmonary-assisted condition comparing the simulation outcome (Sim) with measured literature data (Me). The results show that the numerical model can well reproduce experimental data in all three conditions (baseline, Fontan and assisted Fontan) [cardiac output (l/min): Me = 2.8 ± 1.7, Sim = 2.8 ± 1.8; ejection fraction (%): Me = 57 ± 17, Sim = 54 ± 17; arterial systemic pressure (mmHg): Me = 41.8 ± 18.6, Sim = 43.8 ± 18.1; pulmonary arterial pressure (mmHg): Me = 15.4 ± 8.9, Sim = 17.7 ± 9.9; caval pressure (mmHg): Me = 6.8 ± 4.1, Sim = 7 ± 4.6]. Systolic elastance, arterial systemic and arterial pulmonary resistances increase (10, 69, and 100 %) passing from the biventricular circulation to the Fontan physiology and then decrease (21, 39, and 50 %) once the VAD was implanted. The ventricular external work decreases (71 %) passing from the biventricular circulation to the Fontan physiology and it increases three times after the VAD implantation in parallel with the VAD power consumption. A numerical model could support clinicians in an innovative and challenging field as the use of VAD to assist the Fontan physiology and it could be helpful to personalize the VAD insertion on the base of ventricular systo-diastolic function, circulatory parameters and energetic variables.
authors.affiliation: Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy. arianna.dimolfetta@gmail.com.
authors.forename: Arianna
authors.initials: A
authors.lastname: Di Molfetta
authors.affiliation: Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amodeo
authors.affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Libera
authors.initials: L
authors.lastname: Fresiello
authors.affiliation: Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Filippelli
authors.affiliation: Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Pilati
authors.affiliation: Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Iacobelli
authors.affiliation: Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Adorisio
authors.affiliation: Cardiac Surgery Intensive Care Unit, University of Tor Vergata, Rome, Italy.
authors.forename: Dionisio
authors.initials: D
authors.lastname: Colella
authors.affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferrari
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D003198:Computer Simulation; D018729:Fontan Procedure; D006321:Heart; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D008955:Models, Cardiovascular; D011651:Pulmonary Artery / Q000502:physiology; D013552:Swine; D013599:Systole
keywords: Fontan; Lumped parameter model; VAD