title: Vortical flow characteristics of mechanical cavopulmonary assistance: Pre- and post-swirl dynamics.
abstract: Surgical optimization of the cavopulmonary connection and pharmacological therapy for dysfunctional Fontan physiology continue to advance, but these treatment approaches only slow the progression of decline to end-stage heart failure. The development of a mechanical cavopulmonary assist device will provide a viable therapeutic option in the bridging of patients to transplant or to stabilization. We hypothesize that rotational blood flow, delivered by an implantable axial flow blood pump, could effectively assist the venous circulation in Fontan patients by mimicking vortical blood flow patterns in the cardiovascular system. This study investigated seven new models of mechanical cavopulmonary assistance (single and dual-pump assist), created combinations of pump designs that deliver counter rotating vortical flow conditions, and analyzed pump performance, velocity streamlines, swirling strength, and energy augmentation in the cavopulmonary circuit for each support scenario. The model having an axial clockwise-oriented impeller in the inferior vena cava and an axial counterclockwise-oriented impeller rotating in the superior vena cava outperformed all of the support scenarios by enhancing the energy of the cavopulmonary circulation an average of 10.3% over the entire flow range and a maximum of 27.4% at %the higher flow rates. This research will guide the development of axial flow blood pumps for Fontan patients and demonstrated the high probability of %a cardiovascular benefit using counter rotating pumps in a dual support scenario, but found that this is dependent upon the patient-specific cavopulmonary anatomy.
authors.affiliation: School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Throckmorton
authors.affiliation: School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Chopski
authors.affiliation: School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
authors.forename: Shravani N
authors.initials: SN
authors.lastname: Birewar
authors.affiliation: School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
authors.forename: Terence S
authors.initials: TS
authors.lastname: Joa
authors.affiliation: School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Huang
authors.affiliation: Pediatric Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.affiliation: St. Christopher's Hospital for Children, Tenet Healthcare Corporation, Philadelphia, PA, USA.
authors.forename: Randy M
authors.initials: RM
authors.lastname: Stevens
authors.affiliation: Departments of Cardiothoracic Surgery and Medicine, College of Medicine, Drexel University, Philadelphia, PA, USA.
authors.forename: J Yasha
authors.initials: JY
authors.lastname: Kresh
mesh_terms: D006353:Heart-Assist Devices; D006439:Hemodynamics; D011474:Prosthesis Design / Q000295:instrumentation*
keywords: Fontan; Mechanical circulatory assistance; blood pump; heart pump; pediatric circulatory support; rotary blood pump; single ventricle physiology