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A Novel computational approach to optimize Fontan and improve surgical predictability

Award Number: R01HL161507
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 02/01/2022
PERIOD OF PERFORMANCE END DATE: 01/31/2027

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A Novel computational approach to optimize Fontan and improve surgical predictability - An efficient hemodynamics with minimal thrombosis risk post-surgery is essential for short- and long-term success of a cardiac surgery. Achieving this is a challenge in cardiac surgery that involves the design of a complex flow pathway. Aortic arch reconstruction, aneurysm repair, Fontan surgeries are a few examples. The Fontan surgical procedure is the most effective palliative treatment for patients with single ventricle defects (SVD). SVD refers to a collection of congenital heart diseases where one of the lower ventricular chambers of the heart remains underdeveloped. Fontan procedure involves re-routing of deoxygenated blood from upper and lower body to flow directly to lungs allowing the single functioning ventricle to pump blood for systemic circulation. Though lifesaving, the Fontan physiology creates a non-natural pathway for venous return of the blood to the lungs thus producing a non-physiological blood flow. A successful Fontan procedure should involve 1) well-balanced overall and hepatic venous flow return to lungs to prevent pulmonary arteriovenous malformations (PAVMs) that can lead to poor gas exchange, 2) minimal energy loss, and 3) minimal thrombosis (blood clot) risk. Complications such as PAVMs and thrombosis post-surgery can result in a Fontan failure. To improve Fontan surgical planning, its efficacy and predictability, we propose to develop an automated image-based computational fluid dynamics (CFD) workflow capable of optimizing and predicting all the above determinants for a successful Fontan physiology. CFD models have been developed in the past to assess energy loss and hepatic venous flow distribution, but an automated computational tool for rapidly optimizing the patients' Fontan physiology in terms of factors affecting success does not exist. To fill this gap, we will integrate our existing patient-specific Fontan surgical planning protocol to predict energy loss and hepatic venous flow distribution with 1) a shape optimization algorithm and 2) our validated model of blood coagulation to provide a computational tool to virtually improve the planned Fontan physiology for optimal hepatic and overall venous return to lungs, minimal energy loss and thrombotic potential and quantitatively predict thrombosis risk. We will completely automate our workflow with custom scripts to minimize errors and user intervention. Our biochemical model of blood coagulation has all the components representing platelet and fibrin deposition and is 2-way coupled with blood flow. The continuum-based approach of this model allows it to be used in large geometries. After rigorous validation of our surgical optimization workflow using MRI-based patient specific in-vitro models, we will perform virtual surgeries using our tool and retrospective patient data to establish clinical applicability. Our tool could potentially be 1) included in the current surgical planning workflow to perform virtual surgeries using patient pre-op data to improve and predict surgical outcomes, and 2) used to evaluate risk of clotting post- Fontan so that patients can be selectively monitored. Our long-term objective is to provide a prospective surgical planning tool for Fontan and then extend it other surgeries where such optimization can improve surgical efficacy.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $568,267 )
2026	2026	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	000	5	3/9/2026	NON-COMPETING CONTINUATION	$568,267
														Subtotal = $568,267

Issue Date FY: 2025 ( Subtotal = $598,175 )
2025	2025	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	000	4	1/24/2025	NON-COMPETING CONTINUATION	$538,358
2025	2025	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	001	4	8/4/2025	NON-COMPETING CONTINUATION	$59,817
														Subtotal = $598,175

Issue Date FY: 2024 ( Subtotal = $586,212 )
2024	2024	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	001	3	6/19/2024	NON-COMPETING CONTINUATION	$47,854
2024	2024	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	000	3	2/1/2024	NON-COMPETING CONTINUATION	$538,358
														Subtotal = $586,212

Issue Date FY: 2023 ( Subtotal = $598,175 )
2023	2023	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	000	2	1/22/2023	NON-COMPETING CONTINUATION	$538,358
2023	2023	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	001	2	5/11/2023	NON-COMPETING CONTINUATION	$59,817
														Subtotal = $598,175

Issue Date FY: 2022 ( Subtotal = $627,547 )
2022	2022	CHILDREN'S HOSPITAL CORPORATION, THE	300 LONGWOOD AVE	BOSTON	MA	02115	SUFFOLK	USA	Cardiovascular Diseases Research	000	1	1/27/2022	NEW	$627,547
														Subtotal = $627,547

Grand Total All Awards = $2,978,376

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A Novel computational approach to optimize Fontan and improve surgical predictability

Award Number: R01HL161507

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 02/01/2022

PERIOD OF PERFORMANCE END DATE: 01/31/2027

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