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Biomechanical Analysis of Age-Dependent Changes in Fontan Power Loss.

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Title: Biomechanical Analysis of Age-Dependent Changes in Fontan Power Loss.
Authors: Sahni, A.1 (AUTHOR), Marshall, L.1 (AUTHOR), Cetatoiu, M. A.1 (AUTHOR), Davee, J.1 (AUTHOR), Schulz, N.1 (AUTHOR), Eickhoff, E. R.1 (AUTHOR), St. Clair, N.1 (AUTHOR), Ghelani, S.2,3 (AUTHOR), Prakash, A.2,3 (AUTHOR), Hammer, P. E.1,4 (AUTHOR), Hoganson, D. M.1,4 (AUTHOR), del Nido, P. J.1,4 (AUTHOR), Rathod, R. H.2,3 (AUTHOR), Govindarajan, Vijay1,4,5 (AUTHOR) vijay.govindarajan@childrens.harvard.edu
Source: Annals of Biomedical Engineering. Sep2024, Vol. 52 Issue 9, p2440-2456. 17p.
Subjects: Vena cava superior, Vena cava inferior, Cardiac surgery, Vortex motion, Tunnels
Abstract: The hemodynamics in Fontan patients with single ventricles rely on favorable flow and energetics, especially in the absence of a subpulmonary ventricle. Age-related changes in energetics for extracardiac and lateral tunnel Fontan procedures are not well understood. Vorticity (VOR) and viscous dissipation rate (VDR) are two descriptors that can provide insights into flow dynamics and dissipative areas in Fontan pathways, potentially contributing to power loss. This study examined power loss and its correlation with spatio-temporal flow descriptors (vorticity and VDR). Data from 414 Fontan patients were used to establish a relationship between the superior vena cava (SVC) to inferior vena cava (IVC) flow ratio and age. Computational flow modeling was conducted for both extracardiac conduits (ECC, n = 16) and lateral tunnels (LT, n = 25) at different caval inflow ratios of 2, 1, and 0.5 that corresponded with ages 3, 8, and 15+. In both cohorts, vorticity and VDR correlated well with PL, but ECC cohort exhibited a slightly stronger correlation for PL-VOR (>0.83) and PL-VDR (>0.89) than that for LT cohort (>0.76 and > 0.77, respectively) at all ages. Our data also suggested that absolute and indexed PL increase (p < 0.02) non-linearly as caval inflow changes with age and are highly patient-specific. Comparison of indexed power loss between our ECC and LT cohort showed that while ECC had a slightly higher median PL for all 3 caval inflow ratio examined (3.3, 8.3, 15.3) as opposed to (2.7, 7.6, 14.8), these differences were statistically non-significant. Lastly, there was a consistent rise in pressure gradient across the TCPC with age-related increase in IVC flows for both ECC and LT Fontan patient cohort. Our study provided hemodynamic insights into Fontan energetics and how they are impacted by age-dependent change in caval inflow. This workflow may help assess the long-term sustainability of the Fontan circulation and inform the design of more efficient Fontan conduits. [ABSTRACT FROM AUTHOR]
Copyright of Annals of Biomedical Engineering is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Biomechanical Analysis of Age-Dependent Changes in Fontan Power Loss.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sahni%2C+A%2E%22&quot;&gt;Sahni, A.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Marshall%2C+L%2E%22&quot;&gt;Marshall, L.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Cetatoiu%2C+M%2E+A%2E%22&quot;&gt;Cetatoiu, M. A.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Davee%2C+J%2E%22&quot;&gt;Davee, J.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Schulz%2C+N%2E%22&quot;&gt;Schulz, N.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Eickhoff%2C+E%2E+R%2E%22&quot;&gt;Eickhoff, E. R.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22St%2E+Clair%2C+N%2E%22&quot;&gt;St. Clair, N.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ghelani%2C+S%2E%22&quot;&gt;Ghelani, S.&lt;/searchLink&gt;&lt;relatesTo&gt;2,3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Prakash%2C+A%2E%22&quot;&gt;Prakash, A.&lt;/searchLink&gt;&lt;relatesTo&gt;2,3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hammer%2C+P%2E+E%2E%22&quot;&gt;Hammer, P. E.&lt;/searchLink&gt;&lt;relatesTo&gt;1,4&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hoganson%2C+D%2E+M%2E%22&quot;&gt;Hoganson, D. M.&lt;/searchLink&gt;&lt;relatesTo&gt;1,4&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22del+Nido%2C+P%2E+J%2E%22&quot;&gt;del Nido, P. J.&lt;/searchLink&gt;&lt;relatesTo&gt;1,4&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rathod%2C+R%2E+H%2E%22&quot;&gt;Rathod, R. H.&lt;/searchLink&gt;&lt;relatesTo&gt;2,3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Govindarajan%2C+Vijay%22&quot;&gt;Govindarajan, Vijay&lt;/searchLink&gt;&lt;relatesTo&gt;1,4,5&lt;/relatesTo&gt; (AUTHOR)&lt;i&gt; vijay.govindarajan@childrens.harvard.edu&lt;/i&gt;
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  Data: The hemodynamics in Fontan patients with single ventricles rely on favorable flow and energetics, especially in the absence of a subpulmonary ventricle. Age-related changes in energetics for extracardiac and lateral tunnel Fontan procedures are not well understood. Vorticity (VOR) and viscous dissipation rate (VDR) are two descriptors that can provide insights into flow dynamics and dissipative areas in Fontan pathways, potentially contributing to power loss. This study examined power loss and its correlation with spatio-temporal flow descriptors (vorticity and VDR). Data from 414 Fontan patients were used to establish a relationship between the superior vena cava (SVC) to inferior vena cava (IVC) flow ratio and age. Computational flow modeling was conducted for both extracardiac conduits (ECC, n = 16) and lateral tunnels (LT, n = 25) at different caval inflow ratios of 2, 1, and 0.5 that corresponded with ages 3, 8, and 15+. In both cohorts, vorticity and VDR correlated well with PL, but ECC cohort exhibited a slightly stronger correlation for PL-VOR (&gt;0.83) and PL-VDR (&gt;0.89) than that for LT cohort (&gt;0.76 and &gt; 0.77, respectively) at all ages. Our data also suggested that absolute and indexed PL increase (p &lt; 0.02) non-linearly as caval inflow changes with age and are highly patient-specific. Comparison of indexed power loss between our ECC and LT cohort showed that while ECC had a slightly higher median PL for all 3 caval inflow ratio examined (3.3, 8.3, 15.3) as opposed to (2.7, 7.6, 14.8), these differences were statistically non-significant. Lastly, there was a consistent rise in pressure gradient across the TCPC with age-related increase in IVC flows for both ECC and LT Fontan patient cohort. Our study provided hemodynamic insights into Fontan energetics and how they are impacted by age-dependent change in caval inflow. This workflow may help assess the long-term sustainability of the Fontan circulation and inform the design of more efficient Fontan conduits. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Annals of Biomedical Engineering is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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              Text: Sep2024
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