Christopher R. Broda, MD, Doris A. Taylor, PhD, Iki Adachi, MD

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Presentation transcript:

Progress in experimental and clinical subpulmonary assistance for Fontan circulation Christopher R. Broda, MD, Doris A. Taylor, PhD, Iki Adachi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 5, Pages 1949-1956 (November 2018) DOI: 10.1016/j.jtcvs.2018.04.102 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Subpulmonary Fontan assistance strategies. Biological assists have been primarily composed of autologous skeletal muscle–based ventricles or wraps. Mechanical assist strategies can be categorized between intravascular and extravascular-based devices. Intravascular assists include axial flow devices, catheter-based assist devices, and von Karman impeller pump. Extravascular assists consist of balloon-cuff or sequential “peristaltic” compression scenarios. SkM, Skeletal muscle. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1949-1956DOI: (10.1016/j.jtcvs.2018.04.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Biological Fontan assists. A, Skeletal muscle ventricle fashioned from LD connected to a mock circulation device19 (permission for reprint obtained from Wolters Kluwer Health, Inc). B, Skeletal muscle wrap is placed around the atrium in an atriopulmonary Fontan connection scenario20 (permission for reprint obtained from Oxford University Press). SMV, Skeletal muscle ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1949-1956DOI: (10.1016/j.jtcvs.2018.04.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Intravascular mechanical Fontan assists. A, Axial flow device. Two devices are used, 1 each in the SVC and IVC33 (permission for reprint obtained from Elsevier). B, Catheter-based device is placed in an acute model of atriopulmonary Fontan connection34 (permission for reprint obtained from Wolters Kluwer Health, Inc). C, von Karman impeller pump is placed in the center of the TCPC35 (permission for reprint obtained from Elsevier). The rotating disc radially displaces fluid and reduces power loss. AAo, Ascending aorta; RPA, right pulmonary artery; SVC, superior vena cava; MPA, main pulmonary artery; LPA, left pulmonary artery; RA, right atrium; RV, right ventricle; IVC, inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1949-1956DOI: (10.1016/j.jtcvs.2018.04.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Extravascular mechanical Fontan assists. A, Balloon-cuff device attached to a modified Fontan connection scenario in which both caval flows input to the modified connection55 (permission for reprint obtained from John Wiley and Sons). B, Sequential compression device designed from multiple shape memory allow rings placed around an extracardiac conduit for an assist scenario56 (Permission for reprint obtained from IEEE). SVC, Superior vena cava; RPA, right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery; RA, right atrium; IVC, inferior vena cava; PA, pulmonary artery; LA, left atrium; SV, single ventricle. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1949-1956DOI: (10.1016/j.jtcvs.2018.04.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Experimental subpulmonary assist device for Fontan circulation: von Karman impeller pump. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1949-1956DOI: (10.1016/j.jtcvs.2018.04.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 A detailed summary of the article in slide show format is narrated by Chris Broda, MD. Video available at: https://www.jtcvs.org/article/S0022-5223(18)31241-8/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1949-1956DOI: (10.1016/j.jtcvs.2018.04.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions