Virtual surgical planning, flow simulation, and 3-dimensional electrospinning of patient-specific grafts to optimize Fontan hemodynamics

J Thorac Cardiovasc Surg. 2018 Apr;155(4):1734-1742. doi: 10.1016/j.jtcvs.2017.11.068. Epub 2017 Dec 5.


Background: Despite advances in the Fontan procedure, there is an unmet clinical need for patient-specific graft designs that are optimized for variations in patient anatomy. The objective of this study is to design and produce patient-specific Fontan geometries, with the goal of improving hepatic flow distribution (HFD) and reducing power loss (Ploss), and manufacturing these designs by electrospinning.

Methods: Cardiac magnetic resonance imaging data from patients who previously underwent a Fontan procedure (n = 2) was used to create 3-dimensional models of their native Fontan geometry using standard image segmentation and geometry reconstruction software. For each patient, alternative designs were explored in silico, including tube-shaped and bifurcated conduits, and their performance in terms of Ploss and HFD probed by computational fluid dynamic (CFD) simulations. The best-performing options were then fabricated using electrospinning.

Results: CFD simulations showed that the bifurcated conduit improved HFD between the left and right pulmonary arteries, whereas both types of conduits reduced Ploss. In vitro testing with a flow-loop chamber supported the CFD results. The proposed designs were then successfully electrospun into tissue-engineered vascular grafts.

Conclusions: Our unique virtual cardiac surgery approach has the potential to improve the quality of surgery by manufacturing patient-specific designs before surgery, that are also optimized with balanced HFD and minimal Ploss, based on refinement of commercially available options for image segmentation, computer-aided design, and flow simulations.

Keywords: 3D printing; flow dynamics; patient specific model; virtual surgical planning.

Publication types

  • Video-Audio Media

MeSH terms

  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Computer-Aided Design*
  • Fontan Procedure / instrumentation*
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Hemodynamics*
  • Humans
  • Hydrodynamics
  • Magnetic Resonance Angiography
  • Models, Cardiovascular
  • Patient-Specific Modeling*
  • Predictive Value of Tests
  • Printing, Three-Dimensional*
  • Prosthesis Design*
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / physiopathology
  • Pulmonary Artery / surgery*
  • Pulmonary Circulation
  • Surgery, Computer-Assisted
  • Treatment Outcome
  • Workflow