Review on Mechanical Support and Cell-Based Therapies for the Prevention and Recovery of the Failed Fontan-Kreutzer Circulation

Frontiers in Pediatrics

Margaret R. Ferrari¹  Jeffrey G. Jacot²  Michael V. Di Maria³ 

[1] Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;

关键词: mechanical assist devices;    stem cell therapies;    hypoplastic left heart syndrome;    Fontan failure;    right ventricular dysfunction;    cardiac tissue engineering;    single ventricle disease;   

DOI  :  10.3389/fped.2020.627660

来源: Frontiers

【 摘 要 】

Though the current staged surgical strategy for palliation of single ventricle heart disease, culminating in a Fontan circulation, has increased short-term survival, mounting evidence has shown that the single ventricle, especially a morphologic right ventricle (RV), is inadequate for long-term circulatory support. In addition to high rates of ventricular failure, high central venous pressures (CVP) lead to liver fibrosis or cirrhosis, lymphatic dysfunction, kidney failure, and other comorbidities. In this review, we discuss the complications seen with Fontan physiology, including causes of ventricular and multi-organ failure. We then evaluate the clinical use, results, and limitations of long-term mechanical assist devices intended to reduce RV work and high CVP, as well as biological therapies for failed Fontan circulations. Finally, we discuss experimental tissue engineering solutions designed to prevent Fontan circulation failure and evaluate knowledge gaps and needed technology development to realize a more robust single ventricle therapy.

【 授权许可】

CC BY