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Insights into Fontan Physiology from Animal VAD Models: Push vs Pull


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Pranava Sinha, MD
Children's National Medical Center
Washington, DC, USA



While the focus of most research on mechanical assistance of failing Fontan circulation is based on providing a subpulmonary pump (artificial RV) to push blood through the passive Fontan circuit, researchers at Children's National Medical Center have proposed a novel concept of pulling blood through the Fontan circuit by using a standard left (systemic) ventricular assist device.

This concept was proven in a large animal Fontan model through the restoration of cardiac output to almost baseline biventricular levels using an atrial inflow and ventricular outflow configuration.

What was more interesting is that the augmentation in the cardiac output was even greater in partial (Bidirectional Glenn) rather than total cavopulmonary connection (Fontan) circuits. This significant increase in total flows resulted in increased oxygen delivery to the tissues despite more desaturation in the assisted Glenn. ■

Disclosure Statement: the author has no conflicts of interest to disclose


References:

  1. Sinha P, Deutsch N, Ratnayaka K, et al. Effect of mechanical assistance of the systemic ventricle in single ventricle circulation with cavopulmonary connection. The Journal of Thoracic and Cardiovascular Surgery 2014;147(4):1271-5.



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