Boston - American Association for Thoracic Surgery

More documents

Recommendations

Info

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTST4. Cavopulmonary Assist Using a Percutaneous, Bi-Conical, SingleImpeller Pump: A New Spin for Fontan Circulatory SupportMark D. Rodefeld, 1* Brandon Coats, 2 Travis Fisher, 2 John Brown, 1* Steve Frankel 21. Department of Surgery, Indiana University School of Medicine, Indianapolis,IN, USA; 2. Purdue University Department of Mechanical Engineering, WestLafayette, IN, USAInvited Discussant: Glen S. Van ArsdellOBJECTIVE: In a univentricular Fontan circulation, a delicate balance exists betweenthe systemic venous and pulmonary arterial circulations. Modest augmentation(2–5 mmHg) of existing cavopulmonary flow would reduce systemic venous pressure,improve ventricular filling, and substantially improve hemodynamic status. Areasonable means of providing high-volume, low-pressure flow in this unique situationdoes not exist. We hypothesized that an expandable single impeller pump,based on the von Karman viscous pump principle, is ideal for this function.METHODS: A 3-dimensional computational fluid dynamics (CFD) model of thetotal cavopulmonary connection (TCPC) was created. The impeller was representedby an actuator disk (a 2-sided conical disk) positioned in the center of the TCPCintersection with rotation in the vena caval axis. Flow was modeled under 3 conditions:1) passive flow with no disc present; 2) passive flow with a non-rotating disk,and 3) flow with a rotating disc (1K, 5K, and 10K rpm). Flow patterns, pressuregradient, and flow rate were estimated for each case. In vitro performance of a flexible2-sided conical disk impeller and protective cage was assessed by measuringpressure rise and induced flow rate at 5K, 10K, and 15K rpm.Cavopulmonary assist* AATS Member202
AMERICAN ASSOCIATION FOR THORACIC SURGERYRESULTS: The presence of an actuator disc alone (nonrotating) stabilizes TCPCflow patterns and offsets the hydraulic energy loss which occurs when no disk ispresent at all. Disk rotation (5K, 10K, and 15K rpm) from a dynamic flow of 4.4 L/min(adult Fontan cardiac output) induced significant flow increases (1.1, 1.7, and 1.9 L/min)with a pressure differential of 1.4, 1.8, and 2.0 mmHg across the TCPC. In vitrovideography confirms bidirectional inflow and outflow augmentation. Experimentalflow rates correlate closely to CFD predictions.CONCLUSION: A simple percutaneous rotary pump, comprised of a singleexpandable bi-conical disk impeller and protective cage, is ideal to provide cavopulmonaryassist. With a single impeller, flow is augmented in all 4 axes, in theideal pressure range, with no venous pathway obstruction. It can apply to both the3-way “T” (bidirectional Glenn) and the 4-way “+” (TCPC) conditions. In patientswith established univentricular Fontan circulations, this provides a previouslyunavailable bridge-to-recovery or -transplant option. It can also provide temporaryperioperative support and enable compression of univentricular palliative proceduresat any stage by substantially improving physiologic status after Fontan conversion.WEDNESDAYMorning203
Page 1 and 2:
American Associationfor Thoracic Su
Page 3 and 4:
AMERICAN ASSOCIATION FOR THORACIC S
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154: AMERICAN ASSOCIATION FOR THORACIC S
Page 203: AMERICAN ASSOCIATION FOR THORACIC S
Page 227 and 228: AATS FUTURE MEETINGSMay 1-5, 2010Me
show all

Boston - American Association for Thoracic Surgery

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?