Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany.
Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
J Artif Organs. 2022 Mar;25(1):1-8. doi: 10.1007/s10047-021-01273-5. Epub 2021 May 6.
An in-vitro study was conducted to investigate the general feasibility of using only one pumping chamber of the SynCardia total artificial heart (TAH) as a replacement of the single ventricle palliated by Fontan circulation. A mock circulation loop was used to mimic a Fontan circulation. The combination of both ventricle sizes (50 and 70 cc) and driver (Freedom Driver and Companion C2 Driver) was investigated. Two clinical relevant scenarios (early Fontan; late Fontan) as derived from literature data were set up in the mock loop. The impact of increased transpulmonary pressure gradient, low atrial pressure, and raised central venous pressure on cardiac output was studied. From a hemodynamic point, the single-chambered TAH performed sufficiently in the setting of the Fontan circulation. Increased transpulmonary pressure gradient, from ideal to pulmonary hypertension, decreased the blood flow in combinations by almost 2 L/min. In the early Fontan scenario, a cardiac output of 3-3.5 L/min was achieved using the 50 cc ventricle, driven by the Companion C2 Driver. Even under pulmonary hypertension, cardiac outputs greater than 4 L/min could be obtained with the 70 cc pump chamber in the late Fontan scenario. In the clinically relevant Fontan scenarios, implementation of the single chambered TAH performed successfully from a hemodynamic point of view. The replacement of the failing univentricular heart by a single chamber of the SynCardia TAH may provide an alternative to a complex biventricular repair procedure or ventricular support in Fontan patients.
一项体外研究旨在探讨仅使用 SynCardia 全人工心脏（TAH）的一个泵腔作为 Fontan 循环单心室姑息治疗替代的一般可行性。使用模拟循环回路来模拟 Fontan 循环。研究了两种心室大小（50 和 70cc）和驱动器（Freedom Driver 和 Companion C2 Driver）的组合。根据文献数据，在模拟回路中设置了两个临床相关场景（早期 Fontan；晚期 Fontan）。研究了增加跨肺压力梯度、低心房压力和升高中心静脉压对心输出量的影响。从血液动力学角度来看，单腔 TAH 在 Fontan 循环中表现良好。跨肺压力梯度从理想状态增加到肺动脉高压，几乎使组合血流量减少 2L/min。在早期 Fontan 场景中，使用 50cc 心室和 Companion C2 Driver 驱动，可实现 3-3.5L/min 的心输出量。即使在肺动脉高压下，晚期 Fontan 场景中使用 70cc 泵腔也可获得大于 4L/min 的心输出量。在临床相关的 Fontan 场景中，从血液动力学角度来看，单腔 TAH 的实施取得了成功。用 SynCardia TAH 的单个腔室替代衰竭的单心室心脏，可能为 Fontan 患者的复杂双心室修复手术或心室支持提供替代方案。
