In Vitro Investigation of Axial Mechanical Support Devices Implanted in the Novel Convergent Cavopulmonary Connection Fontan.

The two opposing inflows and two outflows in a total cavopulmonary connection (TCPC) makes mechanical circulatory support (MCS) extremely challenging. We have previously reported a novel convergent cavopulmonary connection (CCPC) Fontan design that improves baseline characteristics and provides a single inflow and outflow, thus simplifying MCS. This study aims to assess the feasibility of MCS of this novel configuration using axial flow pumps in an in vitro benchtop model. Three-dimensional (3D) segmentations of twelve single ventricle patients (Body Surface Area (BSA) 0.5-1.75 m2) were generated from cardiovascular magnetic resonance images. The CCPC models were designed by connecting the inferior vena cava (IVC) and superior vena cava (SVC) to a shared conduit ascending to the pulmonary arteries (PA), optimized in silico. The twelve TCPC and their corresponding CCPC models underwent in vitro benchtop characterization. Two MCS devices were used, the Impella RP® and the PediPump. MCS successfully and symmetrically reduced the pressure in both vena cavae more than 20 mmHg. The devices improved the hepatic flow distribution (HFD) balance of all CCPC models (Impella RP® P = 0.045, PediPump P = 0.055). The CCPC Fontan design provides a feasible MCS solution for a failing Fontan by balancing HFD and symmetrically decompressing the central venous pressure. Cardiac index may also improve with MCS support. Additional studies are needed to evaluate this concept for managing Fontan failure.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.