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research-article

Increased energy loss due to twist and offset buckling of the total cavopulmonary connection

[+] Author and Article Information
Gokce Nur Oguz

Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
gturkmen14@ku.edu.tr

Senol Piskin

Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
senolpiskin@gmail.com

Erhan Ermek

Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
eermek@ku.edu.tr

Samir Donmazov

Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
sdonmazov@ku.edu.tr

Naz Altekin

Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
naltekin14@ku.edu.tr

Ahmet Arnaz

Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, Istanbul, Turkey
ahmetarnaz@gmail.com

Kerem Pekkan

Department of Mechanical Engineering, Koç University, Sarıyer, Istanbul, Turkey
kpekkan@ku.edu.tr

1Corresponding author.

ASME doi:10.1115/1.4035981 History: Received August 01, 2016; Revised January 27, 2017

Abstract

Recent clinical studies showed that the hemodynamic energy loss of the surgical conduit used in 3rd-stage repair of single-ventricle heart defects (Fontan surgery) determines the post-operative exercise capacity. Still, our understanding of the Fontan pathway energy loss is based on fully-functional conduits that are acquired from patients with optimal post-operative health, while a significant portion of the patients struggle with severe complications due to their gradually failing physiology. In this study, the hemodynamics of severely deformed surgical pathways due to torsional deformation and anastomosis offset, are investigated. We designed a mock-up circuit to replicate the mechanically failed inferior vena cava (IVC) anastomosis morphologies under physiological venous pressure (9, 12, 15 mmHg), in vitro, employing the commonly used conduit materials; PTFE, Dacron and porcine pericardium. For three twist angles (0°, 30°, 60°) and caval offsets (0Diameter, 0.5D and 1D) conduit shapes are digitized in 3D and employed in computational fluid dynamic simulations to determine the corresponding hydrodynamic efficiency levels. A total of 81 deformed configurations are analyzed in which the pressure drop values increased 80 to 1070 % with respect to the uniform diameter IVC conduit. Surgical materials resulted significant variations in terms of flow separation and energy loss. The porcine pericardium and PTFE conduit resulted 8 and 3 times more pressure drop than the Dacron conduit, respectively. If anastomosis twist and/or offset cannot be avoided due to the patients anatomy, alternative materials with high structural stiffness can be considered.

Copyright (c) 2017 by ASME
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