title: Concurrent use of continuous and pulsatile flow Ventricular Assist Device on a fontan patient: A simulation study.
abstract: The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the concurrent use of pulsatile (PVAD) and continuous flow (CVAD) ventricular assist device (VAD) on Fontan patients. Echocardiographic and hemodynamic data of five Fontan patients were retrospectively collected and used to simulate the patients' baseline hemodynamics. Then, for each patient, the following assistance modality was simulated for the cavopulmonary and the single ventricle (SV): (a) CVAD for cavopulmonary assistance (RCF) and PVAD assisting the SV (LCF) (RPF + LCF), (b) CVAD assisting SV and PVAD for cavopulmonary assistance (LPF + RCF). The numerical model can well reproduce patients' baseline. The cardiac output increases more importantly in the LCF + RPF configuration (35 vs. 8%). Ventricular volume decreases more evidently in the configuration LCF + RPF (28 vs. 6%), atrial pressure decreases in the LCF + RPF modality (10%), while it slightly increases in the RCF + LPF modality. The pulmonary arterial pressure slightly decreases (increases) in the configuration RCF + LPF (LCF + RPF). Ventricular external work increases in both configurations because of the total increment of the cardiac output. However, artero-ventricular coupling improves in both configurations: RCF + LPF-14%, LCF + RPF-41%. The pulsatility index decreases (increases) by 8% (13.8%) in the configuration LCF + RPF (RCF + LPF). A model could permit us to simulate extreme physiological conditions of the implantation of both CF and PF VAD on the Fontan patient and could permit to choose the proper VAD on the base of patients' condition. The configuration LCF + RPF seems to maximize the hemodynamic benefits.
authors.affiliation: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù.
authors.forename: Arianna
authors.initials: A
authors.lastname: Di Molfetta
authors.affiliation: Institute of Clinical Physiology, National Research Center, Rome, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferrari
authors.affiliation: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù.
authors.forename: Roberta
authors.initials: R
authors.lastname: Iacobelli
authors.affiliation: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù.
authors.forename: Sergio
authors.initials: S
authors.lastname: Filippelli
authors.affiliation: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amodeo
mesh_terms: D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D004867:Equipment Design; D005260:Female; D018729:Fontan Procedure / Q000295:instrumentation / Q000379:methods; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D011673:Pulsatile Flow; D012189:Retrospective Studies
keywords: -Lumped parameter model; -Single ventricle; -Ventricular assist device; Fontan