Autonomous Fontan Pump: Feasibility Study
Mark Rodefeld, MD1, Shreyas Sarfare2, Alan Palazzolo2, Guruprasad Giridharan3, Mike Neary4, Edward Bennett5.
1Indiana University School of Medicine, Indianapolis, IN, USA, 2Texas A&M University, College Station, TX, USA, 3University of Louisville School of Medicine, Louisville, KY, USA, 4RBTS Inc, Phoenixville, PA, USA, 5Mechanical Solutions Inc, Whippany, NJ, USA.
Objective(s): After Fontan palliation, single ventricle patients are committed to a life of chronic circulatory inefficiency secondary to the lack of a subpulmonary ventricle. A low pressure-rise cavopulmonary assist device that can shift the Fontan circulation toward biventricular equivalency may delay or prevent Fontan failure. A self-powered Fontan pump is described that redistributes reserve pressure energy from the systemic arterial circulation to maintain a subpulmonary power source in a univentricular Fontan circulation.
Methods: Using computational fluid dynamics [CFD], we designed a double-inlet, double-outlet rotary pump to augment Fontan flow through the total cavopulmonary connection [TCPC]. The pump is internally powered by a systemic arterial shunt (1.1 LPM, 22% CO), with closed-loop return to the common atrium (QP:QS 1:1). The pump is scaled for adolescent use and in situ TCPC implantation.
Results: CFD demonstrates flow augmentation in all 4 limbs of the TCPC (SVC/IVC inflow; LPA/RPA outflow) with a pressure rise of +3.82 mmHg in the Fontan circuit. This improvement in Fontan hemodynamics corresponds to a 3.82 mmHg decrease in systemic venous pressure, and a pulmonary arterial pressure increase of 3.82 mmHg (improved systemic preload).
Conclusions: These data suggest feasibility of using reserve pressure energy in the systemic arterial circulation to meaningfully improve Fontan circulatory efficiency. Prototyping, in vitro physiologic characterization under variable conditions, and hemocompatibility optimization are warranted. Potential benefits of an autonomous Fontan pump include biventricular health maintenance, freedom from external power, no percutaneous driveline, autoregulating exercise responsiveness, and maintenance free (other than anticoagulation) service.
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