Date of Award
Doctor of Philosophy (PhD)
Dr. Ethan Kung, Committee Chair
Dr. Richard Figliola
Dr. Joshua Bostwick
Dr. Gregory Mocko
Congenital heart defects are responsible for the mortality of approximately 300,000 newborn each year. One study in 2010 estimated that over 2 million patients were living with congenital heart defects in the United States. Congenital heart defects have the highest hospitalization cost among other birth defect categories. The damage on the U.S economy in 2013 was estimated $6.1 billion. The most complex and severe form of these defects results in single ventricle physiology. Fortunately, over the last 50 years, these patients have been able to survive into adulthood as a result of three stages of surgeries culminating with Fontan operation.
However, Fontan operation as the current ultimate palliation of single ventricle defects results in significant late complications. Fontan patients will eventually develop circulatory failure and are in desperate need of an immediate therapeutic solution. A rightsided device surgically placed in the cavopulmonary pathway could technically substitute the missing sub-pulmonary ventricle by generating a mild pressure boost.
However, currently, there is no device specifically designed for this application due to the small market size. On the other hand, off-label use of an arterial pump (originally designed for left side application) for the cavopulmonary support remains challenging. This is because the hemodynamic impact of a ventricular assist device (VAD) implanted on the right circulation of a Fontan patient is not yet clear. Moreover, further research is needed to identify the physiological consequences of two clinically-considered surgical configurations (IVC and full assisted configurations) for the cavopulmonary VAD installation, with full and IVC support corresponding to the entire venous return or only the inferior venous return, respectively, being routed through the VAD.
First objective of this thesis is surgical planning to accurately predict the outcome of cavopulmonary support in failing Fontan patients and findings of this study will help the surgeons in developing coherent clinical strategies for the cavopulmonary support implementation and tuning. Specific objective 2 will investigate the desired operating region for designing a cavopulmonary blood pump that can offer a promising alternative treatment option for a wide range of failing Fontan patients.
Farahmand, Masoud, "Cavopulmonary Support for Failing Fontan Patients: Computational and In Vitro Assessment" (2019). All Dissertations. 2571.