OR1-2 | Percutaneous creation of Fontan circulation in a large animal model

The Fontan operation is used to palliate single ventricle heart defects. Despite decades of experience with the circulation, significant knowledge gaps remain due a lack of an accessible animal model. We describe a strategy to create an animal model of Fontan circulation using only percutaneous techniques. Adult mini-swine were brought the interventional suite and anesthetized and intubated. Vascular access was obtained and a right heart catheterization was performed. Under fluoroscopic and echocardiographic guidance, a 28 mm x 15 cm covered stent was advanced to the desired position in the subpulmonary circulation, spanning the pulmonary valve and tricuspid valve and subsequently deployed. A final right heart catheterization was performed, the animals were weaned from anesthesia and extubated to room air. Deployment of the covered stent spanning the distance between the pulmonary and tricuspid valves resulted in equalization of the right atrial and pulmonary pressure. Contrast injection in the right atrium demonstrated filling in the covered stent and unobstructed, prograde flow into the pulmonary artery. Direct pressure measurement and pulse-wave Doppler sampling of the conditions in the pulmonary artery show a waveform that is phasic with respiration, rather than pulsatile with the cardiac cycle. These data demonstrate a reproducible, non-surgical approach to exclude the subpulmonary ventricle from the circulation creating a Fontan circulation. More studies are needed to investigate this promising, novel transcatheter model of Fontan circulation in a large mammal.