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A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation

OBJECTIVES: To evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campai...

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Autores principales: Lashkarinia, S Samaneh, Cicek, Murat, Kose, Banu, Rezaeimoghaddam, Mohammad, Yılmaz, Emine Hekim, Aydemir, Numan Ali, Rasooli, Reza, Ozkok, Sercin, Yurtseven, Nurgul, Erdem, Hasan, Pekkan, Kerem, Sasmazel, Ahmet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159461/
https://www.ncbi.nlm.nih.gov/pubmed/35134949
http://dx.doi.org/10.1093/icvts/ivac001
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author Lashkarinia, S Samaneh
Cicek, Murat
Kose, Banu
Rezaeimoghaddam, Mohammad
Yılmaz, Emine Hekim
Aydemir, Numan Ali
Rasooli, Reza
Ozkok, Sercin
Yurtseven, Nurgul
Erdem, Hasan
Pekkan, Kerem
Sasmazel, Ahmet
author_facet Lashkarinia, S Samaneh
Cicek, Murat
Kose, Banu
Rezaeimoghaddam, Mohammad
Yılmaz, Emine Hekim
Aydemir, Numan Ali
Rasooli, Reza
Ozkok, Sercin
Yurtseven, Nurgul
Erdem, Hasan
Pekkan, Kerem
Sasmazel, Ahmet
author_sort Lashkarinia, S Samaneh
collection PubMed
description OBJECTIVES: To evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. METHODS: For 9 patients, aged 2 to18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. RESULTS: The proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. CONCLUSIONS: The new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development. DATE AND NUMBER OF IRB APPROVAL: 25 October 2019, 280011928-604.01.01.
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spelling pubmed-91594612022-06-05 A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation Lashkarinia, S Samaneh Cicek, Murat Kose, Banu Rezaeimoghaddam, Mohammad Yılmaz, Emine Hekim Aydemir, Numan Ali Rasooli, Reza Ozkok, Sercin Yurtseven, Nurgul Erdem, Hasan Pekkan, Kerem Sasmazel, Ahmet Interact Cardiovasc Thorac Surg Congenital OBJECTIVES: To evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. METHODS: For 9 patients, aged 2 to18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. RESULTS: The proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. CONCLUSIONS: The new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development. DATE AND NUMBER OF IRB APPROVAL: 25 October 2019, 280011928-604.01.01. Oxford University Press 2022-02-03 /pmc/articles/PMC9159461/ /pubmed/35134949 http://dx.doi.org/10.1093/icvts/ivac001 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Congenital
Lashkarinia, S Samaneh
Cicek, Murat
Kose, Banu
Rezaeimoghaddam, Mohammad
Yılmaz, Emine Hekim
Aydemir, Numan Ali
Rasooli, Reza
Ozkok, Sercin
Yurtseven, Nurgul
Erdem, Hasan
Pekkan, Kerem
Sasmazel, Ahmet
A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation
title A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation
title_full A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation
title_fullStr A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation
title_full_unstemmed A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation
title_short A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation
title_sort novel fontan y-graft for interrupted inferior vena cava and azygos continuation
topic Congenital
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159461/
https://www.ncbi.nlm.nih.gov/pubmed/35134949
http://dx.doi.org/10.1093/icvts/ivac001
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