Introduction of a new optimized total cavopulmonary connection
Introduction of a new optimized total cavopulmonary connection
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DOI：
10.1016/j.athoracsur.2006.12.079
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发表时间：
2007-06-01
影响因子：
4.6
通讯作者：
Yoganathan, Ajit P.
中科院分区：
文献类型：
--
作者：
Soerensen, Dennis D.;Pekkan, Kerem;Yoganathan, Ajit P.
背景资料。为了获得良好的流体力学和流量分布，已经研究了几种不同的全腔静脉-肺连接(TCPC)。本研究提出了一种血液动力学优化的TCPC构型，代号为“OptiFlo”。以上腔静脉和下腔静脉(上腔静脉和下腔静脉)分叉的下腔静脉为特征，其设计目的是降低连接处的流体机械动力损失，并确保双肺的适当肝血流灌流。建立了OptiFlo TCPC的快速原型模型，并进行了体外控制体积流动分析，以评估模型的流体机械功率损失性能。此外，利用计算流体力学模拟研究了该模型中的流动模式，并与平面单径偏置扩口TCPC的流动模式进行了比较，这是迄今为止已知的最好的TCPC结构。与单径偏移量参考模型相比，OptiFlo显示出更低的功率损失：在增加2、4和6 L/分钟的心输出量时，功率损失分别为-26%、-31%和-42%。在OptiFlo模型中，40：60和50：50 SVC/IVC血流比率(p>；0.1)之间的功率损失没有统计学差异。与单径偏移量参考模型相比，OptiFlo在不同左、右肺动脉比例下的功率损失特性曲线更平坦。与单径偏移模型相比，OptiFlo模型中的肺动脉血流更加流畅。与平面单径偏置TCPC模型相比，OptiFlo TCPC设计具有更低的功率损耗、更好地将肝脏血液分配到双肺的适应性，以及更低的血流扰动。它在较高心输出量(运动)时显著优越的血流动力学性能使进一步的设计和可行性研究朝着可行的临床模式合理化。
Background. Several variations of the total cavopulmonary connection (TCPC) have been investigated for favorable fluid mechanics and flow distribution. This study presents a hemodynamically optimized TCPC configuration code-named "OptiFlo." Featuring bifurcated vena cava (superior venacava to inferior vena cava SVC/IVC), it was designed to lower the fluid mechanical power losses in the connection and to ensure proper hepatic blood perfusion to both lungs.Methods. A rapid prototype model of the OptiFlo TCPC was built and in vitro control volume flow analysis was performed to evaluate the fluid mechanical power loss performance of the model. Furthermore, computational fluid dynamics simulations were used to investigate the flow patterns in the model, which were compared with those in the planar one-diameter offset TCPC with flared anastomosis sites, the best known TCPC configuration to date.Results. Compared with the one-diameter offset reference model, the OptiFlo showed lower power losses: -26%, -31%, and -42% for increasing cardiac outputs of 2, 4, and 6 L/minute, respectively. No statistically significant differences were found in power loss between 40: 60 and 50: 50 SVC/IVC flow ratios (p > 0.1) for the OptiFlo model. The power loss characteristic curve for different left and right pulmonary artery ratios was flatter for the OptiFlo than the one-diameter offset reference model. Pulmonary artery flow was much more streamlined in the OptiFlo compared with the one-diameter offset model.Conclusions. The OptiFlo TCPC design exhibits lower power losses with better adaptive distribution of hepatic blood to both lungs and lower blood flow disturbances compared with the planar one-diameter offset TCPC model. Its significantly superior hemodynamic performance at higher cardiac outputs (exercise) rationalizes further design and feasibility studies toward a workable clinical model.