A novel fontan Y-graft for interrupted inferior vena cava and azygos continuation
| Autor: | S Samaneh Lashkarinia, Murat Cicek, Banu Kose, Mohammad Rezaeimoghaddam, Emine Hekim Yılmaz, Numan Ali Aydemir, Reza Rasooli, Sercin Ozkok, Nurgul Yurtseven, Hasan Erdem, Kerem Pekkan, Ahmet Sasmazel |
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| Přispěvatelé: | Lashkarinia, S. Samaneh, Pekkan, Kerem (ORCID 0000-0001-7637-4445 & YÖK ID 161845), Rezaeimoghaddam, Mohammad, Rasooli, Reza, Çicek, Murat, Köse, Banu, Yılmaz, Emine Hekim, Aydemir, Numan Ali, Özkök, Serçin, Yurtseven, Nurgül, Erdem, Hasan, Sasmazel, Ahmet, Graduate School of Sciences and Engineering, College of Engineering, Department of Mechanical Engineering |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart Defects Congenital Intratrial Y-Graft 1004 Medical Biotechnology Respiratory System Hemodynamics Single Ventricle 1103 Clinical Sciences Vena Cava Inferior Computational Fluid Dynamics Pulmonary Artery Extracardiac Fontan Procedure Total Cavopulmonary Connection Cardiac and cardiovascular systems Respiratory system Surgery Patient-Specific Analysis Pre-Surgical Planning Humans Total cavopulmonary connection Computational fluid dynamics Y-graft Fontan procedure Pre-surgical planning Single ventricle Patient-specific analysis Cardiology and Cardiovascular Medicine |
| Zdroj: | Interactive Cardiovascular and Thoracic Surgery |
| Popis: | Objectives: to evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. Methods: for 9 patients, aged 2 to 18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. Results: the proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. Conclusions: the new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development. European Union (EU); Horizon 2020; European Research Council (ERC); Proof of Concept Grant; BloodTurbine; ERC Starting Grant; Scientific and Technological Research Council of Turkey (TÜBİTAK); 1003 Priority-Research Program Grant |
| Databáze: | OpenAIRE |
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