Transient hemodynamic changes upon changing a BCPA into a TCPC in staged Fontan operation: a computational model...

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.