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In Vitro Assessment of the Assisted Bidirectional Glenn Procedure for Stage One Single Ventricle Repair

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Abstract

This in vitro study compares the hemodynamic performance of the Norwood and the Glenn circulations to assess the performance of a novel assisted bidirectional Glenn (ABG) procedure for stage one single ventricle surgery. In the ABG, the flow in a bidirectional Glenn procedure is assisted by injection of a high-energy flow stream from the systemic circulation using an aorta-caval shunt with nozzle. The aim is to explore experimentally the potential of the ABG as a surgical alternative to current surgical practice. The experiments are directly compared against previously published numerical simulations. A multiscale mock circulatory system was used to measure the hemodynamic performance of the three circulations. For each circulation, the system was tested using both low and high values of pulmonary vascular resistance. Resulting parameters measured were: pressure and flow rate at left/right pulmonary artery and superior vena cava (SVC). Systemic oxygen delivery (OD) was calculated. A parametric study of the ratio of ABG nozzle to shunt diameter was done. We report time-based comparisons with numerical simulations for the three surgical variants tested. The ABG circulation demonstrated an increase of 30–38% in pulmonary flow with a 2–3.7 mmHg increase in SVC pressure compared to the Glenn and a 4–14% higher systemic OD than either the Norwood or the Glenn. The nozzle/shunt diameter ratio affected the local hemodynamics. These experimental results agreed with those of the numerical model: mean flow values were not significantly different (p > 0.05) while mean pressures were comparable within 1.2 mmHg. The results verify the approaches providing two tools to study this complicated circulation. Using a realistic experimental model we demonstrate the performance of a novel surgical procedure with potential to improve patient hemodynamics in early palliation of the univentricular circulation.

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Acknowledgments

This work was partly supported by the Leducq Foundation through a Transatlantic Network of Excellence grant. Support for ALM and MEM was also provided by a Burroughs Wellcome Fund Career Award at the Scientific Interface and NSF CAREER OCI-1150184.

Conflict of interest

Jian Zhou, Timothy Conover, Mahdi Esmaily-Moghadam, Tain-Yen Hsia, Alison L. Marsden and Richard Figliola declare that they have no conflicts of interest. Jian Zhou, Timothy Conover, Tain-Yen Hsia and Richard Figliola report grants from the Leducq Foundation during the conduct of this study. Mahdi Esmaily-Moghadam and Alison L. Marsden reports grants from the Leducq Foundation, grants from the Burroughs Wellcome Fund, grants from the National Science Foundation, during the conduct of the study.

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Correspondence to Richard S. Figliola.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

MOCHA Investigators: Andrew Taylor, Alessandro Giardini, Sachin Khambadkone, Silvia Schievano, Marc de Leval, and T.-Y. Hsia (Institute of Cardiovascular Sciences, London, United Kingdom); Edward Bove, and Adam Dorfman, (University of Michigan, Ann Arbor, MI); G. Hamilton Baker and Anthony Hlavacek (Medical University of South Carolina, Charleston, SC); Francesco Migliavacca, Giancarlo Pennati, and Gabriele Dubini (Politecnico di Milano, Milan, Italy); Alison Marsden, (University of California, San Diego, CA); Irene Vignon-Clementel (National Institute of Research in Informatics and Automation, Paris, France); Richard Figliola and John McGregor (Clemson University, Clemson, SC.

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Zhou, J., Esmaily-Moghadam, M., Conover, T.A. et al. In Vitro Assessment of the Assisted Bidirectional Glenn Procedure for Stage One Single Ventricle Repair. Cardiovasc Eng Tech 6, 256–267 (2015). https://doi.org/10.1007/s13239-015-0232-z

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