Phillip M Trusty1, Zhenglun Wei1, Megan Sales2, Kirk R Kanter3, Mark A Fogel4, Ajit P Yoganathan5, Timothy C Slesnick6. 1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga. 2. School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Ga. 3. Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. 4. Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa. 5. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga. Electronic address: ajit.yoganathan@bme.gatech.edu. 6. Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
Abstract
OBJECTIVE: The use of Y-grafts for Fontan completion is hypothesized to offer more balanced hepatic flow distribution (HFD) and decreased energy losses. The purpose of this study was to evaluate the hemodynamic performance of Y-grafts over time using serial cardiac magnetic resonance data and to compare their performance with extracardiac Fontan connections. METHODS: Ten Fontan patients with commercially available Y-graft connections and serial postoperative cardiac magnetic resonance data were included in this study. Patient-specific computational fluid dynamics simulations were used to estimate HFD and energy losses. Y-graft performance was compared with 3 extracardiac conduit Fontan groups (n = 10 for each) whose follow-up times straddle the Y-graft time points. RESULTS: Y-graft HFD became significantly more balanced over time (deviation from 50% decreased from 18% ± 14% to 8% ± 8%; P = .015). Total cavopulmonary connection resistance did not significantly change. Y-grafts at 3-year follow-up showed more balanced HFD than the extracardiac conduit groups at both the earlier and later follow-up times. Total cavopulmonary connection resistance was not significantly different between any Y-graft or extracardiac conduit group. CONCLUSIONS: Y-grafts showed significantly more balanced HFD over a 3-year follow-up without an increase in total cavopulmonary connection resistance, and therefore may be a valuable option for Fontan completion. Additional follow-up data at longer follow-up times are still needed to thoroughly characterize the potential advantages of Y-graft use.
OBJECTIVE: The use of Y-grafts for Fontan completion is hypothesized to offer more balanced hepatic flow distribution (HFD) and decreased energy losses. The purpose of this study was to evaluate the hemodynamic performance of Y-grafts over time using serial cardiac magnetic resonance data and to compare their performance with extracardiac Fontan connections. METHODS: Ten Fontan patients with commercially available Y-graft connections and serial postoperative cardiac magnetic resonance data were included in this study. Patient-specific computational fluid dynamics simulations were used to estimate HFD and energy losses. Y-graft performance was compared with 3 extracardiac conduit Fontan groups (n = 10 for each) whose follow-up times straddle the Y-graft time points. RESULTS: Y-graft HFD became significantly more balanced over time (deviation from 50% decreased from 18% ± 14% to 8% ± 8%; P = .015). Total cavopulmonary connection resistance did not significantly change. Y-grafts at 3-year follow-up showed more balanced HFD than the extracardiac conduit groups at both the earlier and later follow-up times. Total cavopulmonary connection resistance was not significantly different between any Y-graft or extracardiac conduit group. CONCLUSIONS: Y-grafts showed significantly more balanced HFD over a 3-year follow-up without an increase in total cavopulmonary connection resistance, and therefore may be a valuable option for Fontan completion. Additional follow-up data at longer follow-up times are still needed to thoroughly characterize the potential advantages of Y-graft use.
Authors: Zhenglun Alan Wei; Camille Johnson; Phillip Trusty; Morgan Stephens; Wenjun Wu; Ritchie Sharon; Balaji Srimurugan; Brijesh P Kottayil; G S Sunil; Mark A Fogel; Ajit P Yoganathan; Mahesh Kappanayil Journal: Pediatr Cardiol Date: 2020-05-06 Impact factor: 1.655
Authors: Marie Schafstedde; Pavlo Yevtushenko; Sarah Nordmeyer; Peter Kramer; Anastasia Schleiger; Natalia Solowjowa; Felix Berger; Joachim Photiadis; Yaroslav Mykychak; Mi-Young Cho; Stanislav Ovroutski; Titus Kuehne; Jan Brüning Journal: Front Cardiovasc Med Date: 2022-08-03