Multiphysics Simulations of a Bioprinted Pulsatile Fontan Conduit

For single ventricle congenital heart patients, Fontan surgery is the final stage in a series of palliative procedures, bypassing the heart to enable passive flow of de-oxygenated blood from the inferior vena cava (IVC) to the pulmonary arteries. This circulation leads to severely elevated central venous pressure, diminished cardiac output, and thus numerous sequelae and premature mortality. To address these issues, we propose a bioprinted pulsatile conduit to provide a secondary power source for the Fontan circulation. A multiphysics computational framework was developed to predict conduit performance and to guide design prior to printing. Physics components included electrophysiology, cardiomyocyte contractility, and fluid-structure interaction coupled to a closed-loop lumped parameter network representing Fontan physiology. A range of myocardial contractility was considered and simulated. The initial conduit design with adult ventricular cardiomyocyte contractility values coupled to a Purkinje network demonstrated potential to reduce liver (IVC) pressure from 16.4 to 9.3 mmHg and increase cardiac output by 29%. After systematically assessing the impacts of contraction duration, fiber direction, and valve placement on conduit performance, we identified a favorable design that successfully reduces liver pressure to 7.3 mmHg and increases cardiac output by 38%, almost normalizing adverse hemodynamics in the lower venous circulation. Valves at the input and output of the conduit are essential to achieve these satisfactory results; without valves, performance is compromised. However, a potential drawback of the design is the elevation of superior vena cava (SVC) pressure, which varies linearly with liver pressure reduction.