Fontan Surgical Planning: Numerical Simulations Reveal Efficient Geometries Predicting Post-Surgical Outcomes

Computational fluid dynamics has the potential to assist cardiovascular surgeons in making more accurate decisions, allowing the prediction of post-surgical outcomes, provided that pre-surgical conditions are well established. However, the application of current techniques, which are based on volume methods, is still limited to a few specialized centers. Lack of knowledge, coupled with the need for advanced computational resources, can serve as obstacles to implementation. Objective: This study aimed to develop a replicable surgical planning procedure for a simplified and clinically feasible total cavopulmonary geometry.

The finite volume method was used to simulate different configurations of cavopulmonary anastomosis under continuous and pulsatile flow and thus gain a better understanding of blood behavior, energy efficiency, and shear stress in the studied regions.

Two geometries were found to be efficient in distributing blood flow in a physiological manner, with adequate shear stress and energy loss. In addition to the correct placement of the anastomosis, the results underscored the need for attention regarding potential stenoses in pulmonary arteries to obtain adequate geometries.

The developed method proved to be effective for early visualization of post-surgical results, particularly in complex clinical cases. Furthermore, the method contributes to a comprehensive understanding of hemodynamics in the studied area, improving the accuracy of cardiovascular surgical planning.