Publication:
Switching the left and the right hearts: a novel BI-ventricle mechanical support strategy with spared native single-ventricle

dc.contributor.coauthorŞişli, Emrah
dc.contributor.coauthorAka, İbrahim Başar
dc.contributor.coauthorTuncer, Osman Nuri
dc.contributor.coauthorAtay, Yüksel
dc.contributor.coauthorÖzbaran, Mustafa
dc.contributor.departmentDepartment of Mechanical Engineering
dc.contributor.kuauthorYıldırım, Canberk
dc.contributor.kuauthorPekkan, Kerem
dc.date.accessioned2024-12-29T09:36:22Z
dc.date.issued2023
dc.description.abstractEnd-stage Fontan patients with single-ventricle (SV) circulation are often bridged-to-heart transplantation via mechanical circulatory support (MCS). Donor shortage and complexity of the SV physiology demand innovative MCS. In this paper, an out-of-the-box circulation concept, in which the left and right ventricles are switched with each other is introduced as a novel bi-ventricle MCS configuration for the "failing" Fontan patients. In the proposed configuration, the systemic circulation is maintained through a conventional mechanical ventricle assist device (VAD) while the venous circulation is delegated to the native SV. This approach spares the SV and puts it to a new use at the right-side providing the most-needed venous flow pulsatility to the failed Fontan circulation. To analyze its feasibility and performance, eight SV failure modes have been studied via an established multi-compartmental lumped parameter cardiovascular model (LPM). Here the LPM model is experimentally validated against the corresponding pulsatile mock-up flow loop measurements of a representative 15-year-old Fontan patient employing a clinically-approved VAD (Medtronic-HeartWare). The proposed surgical configuration maintained the healthy cardiac index (3-3.5 l/min/m(2)) and the normal mean systemic arterial pressure levels. For a failed SV with low ejection fraction (EF = 26%), representing a typical systemic Fontan failure, the proposed configuration enabled a similar to 28 mmHg amplitude in the venous/pulmonary waveforms and a 2 mmHg decrease in the central venous pressure (CVP) together with acceptable mean pulmonary artery pressures (17.5 mmHg). The pulmonary vascular resistance (PVR)-SV failure case provided a similar to 5 mmHg drop in the CVP, with venous/pulmonary pulsatility reaching to similar to 22 mmHg. For the high PVR failure case with a healthy SV (EF = 44%) pulmonary hypertension is likely to occur as expected. While this condition is routinely encountered during the heart transplantation and managed through pulmonary vasodilators a need for precise functional assessment of the spared failed-ventricle is recommended if utilized in the PVR failure mode. Comprehensive in vitro and in silico results encourage this novel concept as a low-cost, more physiological alternative to the conventional bi-ventricle MCS pending animal experiments.
dc.description.indexedbyWoS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.issue12
dc.description.openaccessGreen Submitted
dc.description.publisherscopeInternational
dc.description.sponsorsWe would like to express our gratitude to Medtronic for providing a loaner HeartWare MCS pump during the <ITALIC>in vitro</ITALIC> experiments.
dc.description.volume51
dc.identifier.doi10.1007/s10439-023-03348-1
dc.identifier.eissn1573-9686
dc.identifier.issn0090-6964
dc.identifier.quartileQ3
dc.identifier.scopus2-s2.0-85169095621
dc.identifier.urihttps://doi.org/10.1007/s10439-023-03348-1
dc.identifier.urihttps://hdl.handle.net/20.500.14288/22024
dc.identifier.wos1063727000001
dc.keywordsSingle-ventricle physiology
dc.keywordsFontan circulation
dc.keywordsHemodynamics
dc.keywordsVentricle assist devices
dc.keywordsMechanical circulatory support
dc.keywordsMock-up flow loops
dc.keywordsLumped parameter modelling
dc.keywordsCongenital heart surgery
dc.keywordsCardiovascular circulation theory
dc.languageen
dc.publisherSpringer
dc.relation.grantnoWe would like to express our gratitude to Medtronic for providing a loaner HeartWare MCS pump during the <italic>in vitro</italic> experiments.
dc.relation.grantnoMedtronic
dc.sourceAnnals of Biomedical Engineering
dc.subjectEngineering
dc.subjectBiomedical
dc.titleSwitching the left and the right hearts: a novel BI-ventricle mechanical support strategy with spared native single-ventricle
dc.typeJournal article
dspace.entity.typePublication
local.contributor.kuauthorYıldırım, Canberk
local.contributor.kuauthorPekkan, Kerem
local.publication.orgunit1Graduate School of Sciences and Engineering
local.publication.orgunit1College of Engineering
local.publication.orgunit2Department of Mechanical Engineering
relation.isOrgUnitOfPublicationba2836f3-206d-4724-918c-f598f0086a36
relation.isOrgUnitOfPublication.latestForDiscoveryba2836f3-206d-4724-918c-f598f0086a36

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