Cavopulmonary assist: Long-term reversal of the Fontan paradox

Mark D. Rodefeld, Alison Marsden, Richard Figliola, Travis Jonas, Michael Neary, Guruprasad A. Giridharan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Fontan circulatory inefficiency can be addressed by replacing the missing subpulmonary power source to reverse the Fontan paradox. An implantable cavopulmonary assist device is described that will simultaneously reduce systemic venous pressure and increase pulmonary arterial pressure, improving preload and cardiac output, in a univentricular Fontan circulation on a long-term basis. Methods: A rotary blood pump that was based on the von Karman viscous pump was designed for implantation into the total cavopulmonary connection (TCPC). It will impart modest pressure energy to augment Fontan flow without risk of obstruction. In the event of rotational failure, it is designed to default to a passive flow diverter. Pressure-flow performance was characterized in vitro in a Fontan mock circulatory loop with blood analog. Results: The pump performed through the fully specified operating range, augmenting flow in all 4 directions of the TCPC. Pressure rise of 6 to 8 mm Hg was readily achieved, ranging to 14 mm Hg at highest speed (5600 rpm). Performance was consistent across a wide range of cardiac outputs. In stalled condition (0 rpm), there was no discernible pressure loss across the TCPC. Conclusions: A blood pump technology is described that can reverse the Fontan paradox and may permit a surgical strategy of long-term biventricular maintenance of a univentricular Fontan circulation. The technology is intended for Fontan failure in which right-sided circulatory inefficiencies predominate and ventricular systolic function is preserved. It may also apply before clinical Fontan failure as health maintenance to preempt the progression of Fontan disease.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Pressure
Cardiac Output
Technology
Electric Power Supplies
Venous Pressure
Ventricular Function
Disease Progression
Arterial Pressure
Maintenance
Equipment and Supplies
Lung
Health
preempt
In Vitro Techniques
Direction compound

Keywords

  • Fontan
  • mechanical circulatory support
  • single ventricle

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Cavopulmonary assist : Long-term reversal of the Fontan paradox. / Rodefeld, Mark D.; Marsden, Alison; Figliola, Richard; Jonas, Travis; Neary, Michael; Giridharan, Guruprasad A.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Rodefeld, Mark D. ; Marsden, Alison ; Figliola, Richard ; Jonas, Travis ; Neary, Michael ; Giridharan, Guruprasad A. / Cavopulmonary assist : Long-term reversal of the Fontan paradox. In: Journal of Thoracic and Cardiovascular Surgery. 2019.
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