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Statistical Shape Modeling for Cavopulmonary Assist Device Development: Variability of Vascular Graft Geometry and Implications for Hemodynamics

[+] Author and Article Information
Jan L Bruse

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 6, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
jan.bruse.12@ucl.ac.uk

Giuliano Giusti

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 6, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
giusti.giul@gmail.com

Catriona Baker

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 6, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
catriona.baker@ucl.ac.uk

Elena Cervi

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 6, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
Elena.Cervi@gosh.nhs.uk

Tain-Yen Hsia

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 7, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
tyhsia@virginmedia.com

Andrew M Taylor

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 7, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
a.taylor76@ucl.ac.uk

Silvia Schievano

Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children Level 6, Nurses Home, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
s.schievano@ucl.ac.uk

1Corresponding author.

ASME doi:10.1115/1.4035865 History: Received July 31, 2016; Revised January 23, 2017

Abstract

Patients born with a single functional ventricle typically undergo three-staged surgical palliation in the first years of life, with the last stage realizing a cross-like total cavopulmonary connection (TCPC) of superior and inferior vena cavas (SVC, IVC) with both left and right pulmonary arteries, allowing all deoxygenated blood to flow passively back to the lungs (Fontan circulation). Even though within the past decades more patients survive into adulthood, the connection comes at the prize of deficiencies such as chronic systemic venous hypertension and low cardiac output, which ultimately may lead to Fontan failure. Studies have suggested that the TCPC's inherent insufficiencies might be addressed by adding a cavopulmonary assist device (CPAD) to provide the necessary pressure boost. While many device concepts are being explored, few take into account the complex cardiac anatomy typically associated with TCPCs. In this study, we focus on the extra cardiac conduit vascular graft connecting IVC and pulmonary arteries as one possible landing zone for a CPAD and describe its geometric variability in a cohort of 18 patients that had their TCPC realized with a 20mm vascular graft. We report traditional morphometric parameters and apply statistical shape modeling to determine the main contributors of graft shape variability. We further compute the anatomical mean 3D graft shape (template graft) as a representative of key shape features of our cohort and proved this template graft to be a significantly better approximation of population and individual patient's hemodynamics than a commonly used simplified tube geometry.

Copyright (c) 2017 by ASME
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