Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections

Citation
Ac. Lardo et al., Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections, J THOR SURG, 117(4), 1999, pp. 697-704
Citations number
27
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN journal
00225223 → ACNP
Volume
117
Issue
4
Year of publication
1999
Pages
697 - 704
Database
ISI
SICI code
0022-5223(199904)117:4<697:FDCOIA>2.0.ZU;2-3
Abstract
Objective: Extracardiac total cavopulmonary connection has recently been in troduced as an alternative to intra-atrial procedures. The purpose of this study was to compare the hydrodynamic efficiency of extracardiac and intra- atrial lateral tunnel procedures in total cavopulmonary connections, Method s: Intra-atrial lateral tunnel, extracardiac tunnel, and extracardiac condu it with and without caval vein offset were performed on explanted sheep hea rt preparations and studied in an in vitro flow loop. A rate of fluid-energ y dissipation analysis was performed for each model using simultaneous meas urement of pressure acid flow at each inlet and outlet of the right side of the heart. Preparations were perfused by using a steady flow blood pump at 4 flow indices (1-6 L/min/m(2)) with the inferior vena cava carrying 65% o f the total venous return. Results: Fluid-power losses were consistently lo wer for the extracardiac conduit procedure compared with the two tunnel con figurations (P < .01). A further reduction in energy dissipation of up to 3 6% was noted in the extracardiac procedure, with 5 mm offset of the extraca rdiac conduit toward the distal right pulmonary, The intra-atrial and extra cardiac tunnel procedures were least efficient, with losses 73% greater tha n the optimal extracardiac conduit procedure, Conclusions: The extracardiac conduit procedure provides superior hemodynamics compared with the intra-a trial lateral tunnel and extracardiac tunnel techniques. This hydrodynamic advantage is markedly enhanced by the use of conduit-superior vena cava off set, particularly at high physiologic flows that are representative of exer cise. These data suggest additional rationale for the use of extracardiac c onduit procedures for final-stage completion of the Fontan circulation.