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J Thorac Cardiovasc Surg. 2018 Apr;155(4):1734-1742. doi: 10.1016/j.jtcvs.2017.11.068. Epub 2017 Dec 5.

Virtual surgical planning, flow simulation, and 3-dimensional electrospinning of patient-specific grafts to optimize Fontan hemodynamics.

Author information

1
Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC; Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
2
Division of Cardiology, Children's National Health System, Washington, DC.
3
Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC; Division of Cardiology, Children's National Health System, Washington, DC.
4
Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC.
5
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md.
6
The Interface Group, Institute of Physiology, University of Zürich, Zurich, Switzerland; Swiss National Centre of Competence in Research, Kidney Control of Homeostasis, Zurich, Switzerland.
7
Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
8
Nanofiber Solutions, Inc, Hilliard, Ohio.
9
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md. Electronic address: nhibino1@jhmi.edu.
10
Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC; Department of Mechanical Engineering, University of Maryland, College Park, Md.

Abstract

BACKGROUND:

Despite advances in the Fontan procedure, there is an unmet clinical need for patient-specific graft designs that are optimized for variations in patient anatomy. The objective of this study is to design and produce patient-specific Fontan geometries, with the goal of improving hepatic flow distribution (HFD) and reducing power loss (Ploss), and manufacturing these designs by electrospinning.

METHODS:

Cardiac magnetic resonance imaging data from patients who previously underwent a Fontan procedure (n = 2) was used to create 3-dimensional models of their native Fontan geometry using standard image segmentation and geometry reconstruction software. For each patient, alternative designs were explored in silico, including tube-shaped and bifurcated conduits, and their performance in terms of Ploss and HFD probed by computational fluid dynamic (CFD) simulations. The best-performing options were then fabricated using electrospinning.

RESULTS:

CFD simulations showed that the bifurcated conduit improved HFD between the left and right pulmonary arteries, whereas both types of conduits reduced Ploss. In vitro testing with a flow-loop chamber supported the CFD results. The proposed designs were then successfully electrospun into tissue-engineered vascular grafts.

CONCLUSIONS:

Our unique virtual cardiac surgery approach has the potential to improve the quality of surgery by manufacturing patient-specific designs before surgery, that are also optimized with balanced HFD and minimal Ploss, based on refinement of commercially available options for image segmentation, computer-aided design, and flow simulations.

KEYWORDS:

3D printing; flow dynamics; patient specific model; virtual surgical planning

PMID:
29361303
PMCID:
PMC5860962
[Available on 2019-04-01]
DOI:
10.1016/j.jtcvs.2017.11.068

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