Cavopulmonary assist for the failing fontan circulation: Impact of ventricular function on mechanical support strategy

Guruprasad A. Giridharan, Mickey Ising, Michael A. Sobieski, Steven C. Koenig, Jun Chen, Steven Frankel, Mark D. Rodefeld

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Mechanical circulatory support-either ventricular assist device (VAD, left-sided systemic support) or cavopulmonary assist device (CPAD, right-sided support)-has been suggested as treatment for Fontan failure. The selection of left- versus rightsided support for failing Fontan has not been previously defined. Computer simulation and mock circulation models of pediatric Fontan patients (15-25 kg) with diastolic, systolic, and combined systolic and diastolic dysfunction were developed. The global circulatory response to assisted Fontan flow using VAD (Heart-Ware HVAD, Miami Lakes, FL) support, CPAD (Viscous Impeller Pump, Indianapolis, IN) support, and combined VAD and CPAD support was evaluated. Cavopulmonary assist improves failing Fontan circulation during diastolic dysfunction but preserved systolic function. In the presence of systolic dysfunction and elevated ventricular end-diastolic pressure (VEDP), VAD support augments cardiac output and diminishes VEDP, while increased preload with cavopulmonary assist may worsen circulatory status. Fontan circulation can be stabilized to biventricular values with modest cavopulmonary assist during diastolic dysfunction. Systemic VAD support may be preferable to maintain systemic output during systolic dysfunction. Both systemic and cavopulmonary support may provide best outcome during combined systolic and diastolic dysfunction. These findings may be useful to guide clinical cavopulmonary assist strategies in failing Fontan circulations. ASAIO Journal 2014; 60:707-715.

Original languageEnglish (US)
Pages (from-to)707-715
Number of pages9
JournalASAIO Journal
Volume60
Issue number6
DOIs
StatePublished - Jan 1 2014

Keywords

  • Cavopulmonary support
  • Diastolic dysfunction
  • Failing Fontan
  • Systolic dysfunction
  • VAD support

ASJC Scopus subject areas

  • Biophysics
  • Biomaterials
  • Bioengineering
  • Biomedical Engineering
  • Medicine(all)

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