Cavopulmonary assist for the univentricular Fontan circulation: Von Kármán viscous impeller pump

Mark Rodefeld, Brandon Coats, Travis Fisher, Guruprasad A. Giridharan, Jun Chen, John Brown, Steven H. Frankel

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Objective: In a univentricular Fontan circulation, modest augmentation of existing cavopulmonary pressure head (2-5 mm Hg) would reduce systemic venous pressure, increase ventricular filling, and thus substantially improve circulatory status. An ideal means of providing mechanical cavopulmonary support does not exist. We hypothesized that a viscous impeller pump, based on the von Kármán viscous pump principle, is optimal for this role. Methods: A 3-dimensional computational model of the total cavopulmonary connection was created. The impeller was represented as a smooth 2-sided conical actuator disk with rotation in the vena caval axis. Flow was modeled under 3 conditions: (1) passive flow with no disc; (2) passive flow with a nonrotating disk, and (3) induced flow with disc rotation (0-5K rpm). Flow patterns and hydraulic performance were examined for each case. Hydraulic performance for a vaned impeller was assessed by measuring pressure increase and induced flow over 0 to 7K rpm in a laboratory mock loop. Results: A nonrotating actuator disc stabilized cavopulmonary flow, reducing power loss by 88%. Disk rotation (from baseline dynamic flow of 4.4 L/min) resulted in a pressure increase of 0.03 mm Hg. A further increase in pressure of 5 to 20 mm Hg and 0 to 5 L/min flow was obtained with a vaned impeller at 0 to 7K rpm in a laboratory mock loop. Conclusions: A single viscous impeller pump stabilizes and augments cavopulmonary flow in 4 directions, in the desired pressure range, without venous pathway obstruction. A viscous impeller pump applies to the existing staged protocol as a temporary bridge-to-recovery or -transplant in established univentricular Fontan circulations and may enable compressed palliation of single ventricle without the need for intermediary surgical staging or use of a systemic-to-pulmonary arterial shunt.

Original languageEnglish
Pages (from-to)529-535
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number3
DOIs
StatePublished - Sep 2010

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Pressure
Venae Cavae
Venous Pressure
Transplants
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Cavopulmonary assist for the univentricular Fontan circulation : Von Kármán viscous impeller pump. / Rodefeld, Mark; Coats, Brandon; Fisher, Travis; Giridharan, Guruprasad A.; Chen, Jun; Brown, John; Frankel, Steven H.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No. 3, 09.2010, p. 529-535.

Research output: Contribution to journalArticle

Rodefeld, Mark ; Coats, Brandon ; Fisher, Travis ; Giridharan, Guruprasad A. ; Chen, Jun ; Brown, John ; Frankel, Steven H. / Cavopulmonary assist for the univentricular Fontan circulation : Von Kármán viscous impeller pump. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 140, No. 3. pp. 529-535.
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abstract = "Objective: In a univentricular Fontan circulation, modest augmentation of existing cavopulmonary pressure head (2-5 mm Hg) would reduce systemic venous pressure, increase ventricular filling, and thus substantially improve circulatory status. An ideal means of providing mechanical cavopulmonary support does not exist. We hypothesized that a viscous impeller pump, based on the von K{\'a}rm{\'a}n viscous pump principle, is optimal for this role. Methods: A 3-dimensional computational model of the total cavopulmonary connection was created. The impeller was represented as a smooth 2-sided conical actuator disk with rotation in the vena caval axis. Flow was modeled under 3 conditions: (1) passive flow with no disc; (2) passive flow with a nonrotating disk, and (3) induced flow with disc rotation (0-5K rpm). Flow patterns and hydraulic performance were examined for each case. Hydraulic performance for a vaned impeller was assessed by measuring pressure increase and induced flow over 0 to 7K rpm in a laboratory mock loop. Results: A nonrotating actuator disc stabilized cavopulmonary flow, reducing power loss by 88{\%}. Disk rotation (from baseline dynamic flow of 4.4 L/min) resulted in a pressure increase of 0.03 mm Hg. A further increase in pressure of 5 to 20 mm Hg and 0 to 5 L/min flow was obtained with a vaned impeller at 0 to 7K rpm in a laboratory mock loop. Conclusions: A single viscous impeller pump stabilizes and augments cavopulmonary flow in 4 directions, in the desired pressure range, without venous pathway obstruction. A viscous impeller pump applies to the existing staged protocol as a temporary bridge-to-recovery or -transplant in established univentricular Fontan circulations and may enable compressed palliation of single ventricle without the need for intermediary surgical staging or use of a systemic-to-pulmonary arterial shunt.",
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