title: Mechanically Assisted Total Cavopulmonary Connection With an Axial Flow Pump: Computational and In Vivo Study.
abstract: A relevant number of patients undergoing total cavopulmonary connection (TCPC) experience heart failure (HF). Heart transplant is then the final option when all other treatments fail. The axial flow blood pumps are now the state of the art; however, there is little experience in low-pressure circuits, such as support of the right ventricle or even a TCPC circulation. A new T-shaped model of mechanically assisted TCPC using the "Jarvik Child 2000" axial pump, (flow rates between 1 and 3 L/m in a range of 5000-9000 rpm) was designed, simulated numerically, and then tested in animals. Eight sheep (42-45 kg) were studied: two pilot studies, four pump-supported (PS) TCPC for 3 h, and two not pump-supported (NPS) TCPC. In the PS, the axial pump was set to maintain the baseline cardiac output (CO). Pressures, CO, systemic and pulmonary vascular resistance, lactate levels, and blood gases were recorded for 3 h. Computational fluid dynamics (CFD) study allows us to set the feasible operating condition and the safety margins to minimize the venous collapse risk. In the NPS animals, a circulatory deterioration, with increasing lactate level, occurred rapidly. In the PS animals, there was a stable cardiac index of 2.7 ± 1.4 L/min/m(2), central venous pressure of 12.3 ± 1 mm Hg, and a mean pulmonary artery pressure (PAP) of 18.1 ± 6 after 3 h of support up to 9000 rpm. systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), blood gasses, and arterial lactate levels remained stable to baseline values. No caval collapse occurred. A new pediatric axial flow pump provides normal CO and physiologic stability in a new T-shaped model of TCPC in sheep, in vivo. CFD and in vivo data showed that this experimental arrangement will allow us to evaluate the potential for mechanical support in patients with Fontan failure avoiding major adverse events.
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gandolfo
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Brancaccio
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.|Department of Technology and Health, Italian National Institute of Health, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Donatiello
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Filippelli
authors.affiliation: Department of Cardiology, Policlinico A. Gemelli, Rome, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Perri
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Iannace
authors.affiliation: Department of Cardiology, Policlinico A. Gemelli, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Amario
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Testa
authors.affiliation: Department of Technology and Health, Italian National Institute of Health, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Avenio
authors.affiliation: Department of Technology and Health, Italian National Institute of Health, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Grigioni
authors.affiliation: Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amodeo
mesh_terms: D000818:Animals; D003198:Computer Simulation; D018729:Fontan Procedure / Q000009:adverse effects*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D023421:Models, Animal; D008955:Models, Cardiovascular; D009716:Numerical Analysis, Computer-Assisted; D011474:Prosthesis Design; D012756:Sheep; D013997:Time Factors
keywords: Congenital; Fontan failure; Heart transplantation; Mechanical assist device