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Surgical Planning of the Total Cavopulmonary Connection: Robustness Analysis

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Abstract

In surgical planning of the Fontan connection for single ventricle physiologies, there can be differences between the proposed and implemented options. Here, we developed a surgical planning framework that help determine the best performing option and ensures that the results will be comparable if there are slight geometrical variations. Eight patients with different underlying anatomies were evaluated in this study; surgical variations were created for each connection by changing either angle, offset or baffle diameter. Computational fluid dynamics were performed and the energy efficiency (indexed power loss-iPL) and hepatic flow distribution (HFD) computed. Differences with the original connection were evaluated: iPL was not considerably affected by the changes in geometry. For HFD, the single superior vena cava (SVC) connections presented less variability compared to the other anatomies. The Y-graft connection was the most robust overall, while the extra-cardiac connections showed dependency to offset. Bilateral SVC and interrupted inferior vena cava with azygous continuation showed high variability in HFD. We have developed a framework to assess the robustness of a surgical option for the TCPC; this will be useful to assess the most complex cases where pre-surgery planning could be most beneficial to ensure an efficient and robust hemodynamic performance.

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Acknowledgments

The authors would like to acknowledge Dr. Mark Fogel from the Children’s Hospital of Philadelphia and Dr. Timothy Slesnick from the Children’s Healthcare of Atlanta for the CMR data. This work was made possible thanks to the American Heart Association Pre-Doctoral Fellowship Award13PRE14580005, NHLBI Grants HL67622 and HL098252, and the Petit Undergraduate Research Scholarship from the Georgia Institute of Technology.

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Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA

    Maria Restrepo, Jake Sebring & Ajit Yoganathan

  2. College of Computing, Georgia Institute of Technology, Atlanta, GA, USA

    Mark Luffel & Jarek Rossignac

  3. Division of Cardiothoracic Surgery Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Kirk Kanter

  4. Department of Cardiovascular Surgery, Children’s Hospital Boston, Boston, MA, USA

    Pedro del Nido

  5. Department of Mathematics and Computer Science, Emory University, Atlanta, GA, USA

    Alessandro Veneziani

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  1. Maria Restrepo
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Correspondence to Ajit Yoganathan.

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Associate Editor Umberto Morbiducci oversaw the review of this article.

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Restrepo, M., Luffel, M., Sebring, J. et al. Surgical Planning of the Total Cavopulmonary Connection: Robustness Analysis. Ann Biomed Eng 43, 1321–1334 (2015). https://doi.org/10.1007/s10439-014-1149-7

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  • DOI: https://doi.org/10.1007/s10439-014-1149-7

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