Mechanical cavopulmonary assist for the univentricular Fontan circulation using a novel folding propeller blood pump.

ABSTRACT

A blood pump specifically designed to operate in the unique anatomic and physiologic conditions of a cavopulmonary connection has never been developed. Mechanical augmentation of cavopulmonary blood flow in a univentricular circulation would reduce systemic venous pressure, increase preload to the single ventricle, and temporarily reproduce a scenario analogous to the normal two-ventricle circulation. We hypothesize that a folding propeller blood pump would function optimally in this cavopulmonary circulation. The hydraulic performance of a two-bladed propeller prototype was characterized in an experimental flow loop using a blood analog fluid for 0.5-3.5 lpm at rotational speeds of 3,600-4,000 rpm. We also created five distinctive blood pump designs and evaluated their hydraulic performance using computational fluid dynamics (CFD). The two-bladed prototype performed well over the design range of 0.5-3.5 lpm, producing physiologic pressure rises of 5-18 mm Hg. Building upon this proof-of-concept testing, the CFD analysis of the five numerical models predicted a physiologic pressure range of 5-40 mm Hg over 0.5-4 lpm for rotational speeds of 3,000-7,000 rpm. These preliminary propeller designs and the two-bladed prototype achieved the expected hydraulic performance. Optimization of these configurations will reduce fluid stress levels, remove regions of recirculation, and improve the hydraulic performance of the folding propeller. This propeller design produces the physiologic pressures and flows that are in the ideal range to mechanically support the cavopulmonary circulation and represents an exciting new therapeutic option for the support of a univentricular Fontan circulation.