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Transient hemodynamic changes upon changing a BCPA into a TCPC in staged Fontan operation: a computational model
Fuyou Liang1, Hideaki Senzaki, Zhaofang Yin
1SJTU-CU International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.
Insights
Low vascular resistance improves transpulmonary flow during the bidirectional cavopulmonary anastomosis (BCPA) to total cavopulmonary connection (TCPC) conversion. Diastolic dysfunction and mitral regurgitation do not significantly impact flow, aiding perioperative risk assessment for TCPC surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Computational Fluid Dynamics
Background:
- The Fontan operation is crucial for single-ventricle defects, but perioperative complications persist.
- Understanding hemodynamic shifts during conversion from bidirectional cavopulmonary anastomosis (BCPA) to total cavopulmonary connection (TCPC) is vital.
Purpose of the Study:
- To identify cardiovascular factors influencing hemodynamic changes during the BCPA to TCPC transition.
- To quantify perioperative hemodynamic alterations under diverse cardiovascular conditions.
Main Methods:
- Developed two computational models simulating single-ventricle circulation with BCPA and TCPC.
- Conducted model-based simulations to assess perioperative hemodynamics.
- Quantified transpulmonary flow changes under various cardiovascular states.
Main Results:
- Low pulmonary and/or lower-body vascular resistance positively impacts transpulmonary flow increase during BCPA to TCPC conversion.
- Ventricular diastolic dysfunction and mitral regurgitation, while known risk factors, showed minimal perioperative impact on transpulmonary flow.
- Identified key hemodynamic factors influencing surgical outcomes.
Conclusions:
- Preoperative assessment of cardiovascular function, particularly vascular resistance, can help predict TCPC surgery outcomes.
- Findings offer insights for optimizing perioperative management and risk stratification in single-ventricle palliation.
Abstract:
The clinical benefits of the Fontan operation in treating single-ventricle defects have been well documented. However, perioperative mortality or morbidity remains a critical problem. The purpose of the present study was to identify the cardiovascular factors that dominate the transient hemodynamic changes upon the change of a bidirectional cavopulmonary (Glenn) anastomosis (BCPA) into a total cavopulmonary connection (TCPC). For this purpose, two computational models were constructed to represent, respectively, a single-ventricle circulation with a BCPA and that with a TCPC. A series of model-based simulations were carried out to quantify the perioperative hemodynamic changes under various cardiovascular conditions. Obtained results indicated that the presence of a low pulmonary vascular resistance and/or a low lower-body vascular resistance is beneficial to the increase in transpulmonary flow upon the BCPA to TCPC change. Moreover, it was found that ventricular diastolic dysfunction and mitral valve regurgitation, despite being well-known risk factors for poor postoperative outcomes, do not cause a considerable perioperative reduction in transpulmonary flow. The findings may help physicians to assess the perioperative risk of the TCPC surgery based on preoperative measurement of cardiovascular function.
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