Cavopulmonary Support Operating Criteria for Serving the Failing Fontan Population; A Modeling Investigating

Fontan operation as the current ultimate palliation of single ventricle defects results in significant late complications eventually leading to a failing circulation. It has been suggested that introducing a cavopulmonary assist device to serve the function of the missing subpulmonary ventricle could potentially stabilize the failing Fontan circulation. The objective of this study is to identify the desired operating region for a cavopulmonary blood pump that can offer a promising alternative treatment option for a wide range of failing Fontan patients. By integrating numerical analysis and available clinical information, the interaction of the cavopulmonary support (producing head pressure rise from 2-20mmHg) via the IVC and full assist configurations with a wide range of simulated adult failing patient cases was investigated; with IVC and full assist corresponding to the inferior venous return or the entire venous return, respectively, being routed through the device. We identified the desired hydraulic operating regions for a cavopulmonary assist device by clustering all head pressures and corresponding pump flows that result in hemodynamic improvement for each simulated failing Fontan physiology. The results presented here can serve as the performance criteria for designing cavopulmonary assist devices as well as evaluating off-label use of commercially available left-side blood pumps for failing Fontan cavopulmonary support.