Virtual surgical planning, flow simulation, and 3-dimensional electrospinning of patient-specific grafts to optimize Fontan hemodynamics

Dominik Siallagan, Yue Hin Loke, Laura Olivieri, Justin Opfermann, Chin Siang Ong, Diane de Zélicourt, Anastasios Petrou, Marianne Schmid Daners, Vartan Kurtcuoglu, Mirko Meboldt, Kevin Nelson, Luca Vricella, Jed Johnson, Narutoshi Hibino, Axel Krieger

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1734-1742
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number4
DOIs
StatePublished - Apr 2018

Keywords

  • 3D printing
  • flow dynamics
  • patient specific model
  • virtual surgical planning

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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