Abstract
The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework.
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The authors gratefully acknowledge the financial support provided by the Swiss National Science Foundation through the NCCR Kindey.CH and a Marie Heim-Vögtlin Fellowship (PMPDP2_151255).
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Associate Editor Karol Miller oversaw the review of this article.
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de Zélicourt, D.A., Kurtcuoglu, V. Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure. Ann Biomed Eng 44, 174–186 (2016). https://doi.org/10.1007/s10439-015-1381-9
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DOI: https://doi.org/10.1007/s10439-015-1381-9