TY - JOUR
T1 - Virtual surgical planning, flow simulation, and 3-dimensional electrospinning of patient-specific grafts to optimize Fontan hemodynamics
AU - Siallagan, Dominik
AU - Loke, Yue Hin
AU - Olivieri, Laura
AU - Opfermann, Justin
AU - Ong, Chin Siang
AU - de Zélicourt, Diane
AU - Petrou, Anastasios
AU - Daners, Marianne Schmid
AU - Kurtcuoglu, Vartan
AU - Meboldt, Mirko
AU - Nelson, Kevin
AU - Vricella, Luca
AU - Johnson, Jed
AU - Hibino, Narutoshi
AU - Krieger, Axel
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
PY - 2018/4
Y1 - 2018/4
N2 - Background: Despite advances in the Fontan procedure, there is an unmet clinical need for patient-specific graft designs that are optimized for variations in patient anatomy. The objective of this study is to design and produce patient-specific Fontan geometries, with the goal of improving hepatic flow distribution (HFD) and reducing power loss (Ploss), and manufacturing these designs by electrospinning. Methods: Cardiac magnetic resonance imaging data from patients who previously underwent a Fontan procedure (n = 2) was used to create 3-dimensional models of their native Fontan geometry using standard image segmentation and geometry reconstruction software. For each patient, alternative designs were explored in silico, including tube-shaped and bifurcated conduits, and their performance in terms of Ploss and HFD probed by computational fluid dynamic (CFD) simulations. The best-performing options were then fabricated using electrospinning. Results: CFD simulations showed that the bifurcated conduit improved HFD between the left and right pulmonary arteries, whereas both types of conduits reduced Ploss. In vitro testing with a flow-loop chamber supported the CFD results. The proposed designs were then successfully electrospun into tissue-engineered vascular grafts. Conclusions: Our unique virtual cardiac surgery approach has the potential to improve the quality of surgery by manufacturing patient-specific designs before surgery, that are also optimized with balanced HFD and minimal Ploss, based on refinement of commercially available options for image segmentation, computer-aided design, and flow simulations.
AB - Background: Despite advances in the Fontan procedure, there is an unmet clinical need for patient-specific graft designs that are optimized for variations in patient anatomy. The objective of this study is to design and produce patient-specific Fontan geometries, with the goal of improving hepatic flow distribution (HFD) and reducing power loss (Ploss), and manufacturing these designs by electrospinning. Methods: Cardiac magnetic resonance imaging data from patients who previously underwent a Fontan procedure (n = 2) was used to create 3-dimensional models of their native Fontan geometry using standard image segmentation and geometry reconstruction software. For each patient, alternative designs were explored in silico, including tube-shaped and bifurcated conduits, and their performance in terms of Ploss and HFD probed by computational fluid dynamic (CFD) simulations. The best-performing options were then fabricated using electrospinning. Results: CFD simulations showed that the bifurcated conduit improved HFD between the left and right pulmonary arteries, whereas both types of conduits reduced Ploss. In vitro testing with a flow-loop chamber supported the CFD results. The proposed designs were then successfully electrospun into tissue-engineered vascular grafts. Conclusions: Our unique virtual cardiac surgery approach has the potential to improve the quality of surgery by manufacturing patient-specific designs before surgery, that are also optimized with balanced HFD and minimal Ploss, based on refinement of commercially available options for image segmentation, computer-aided design, and flow simulations.
KW - 3D printing
KW - flow dynamics
KW - patient specific model
KW - virtual surgical planning
UR - http://www.scopus.com/inward/record.url?scp=85040568637&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040568637&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2017.11.068
DO - 10.1016/j.jtcvs.2017.11.068
M3 - Article
C2 - 29361303
AN - SCOPUS:85040568637
SN - 0022-5223
VL - 155
SP - 1734
EP - 1742
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -