Surgical Planning and Optimization of Patient-Specific Fontan Grafts With Uncertain Post-Operative Boundary Conditions and Anastomosis Displacement

Objective:
Fontan surgical planning involves designing grafts to perform optimized hemodynamic performance for the patient’s long-term health benefit. The uncertainty of post-operative boundary conditions (BC) and graft anastomosis displacements can significantly affect optimized graft designs and lead to undesirable outcomes, especially for hepatic flow distribution (HFD). We aim to develop a computation framework to automatically optimize patient-specific Fontan grafts with the maximized possibility of keeping post-operative results within clinical acceptable thresholds.
Methods:
The uncertainties of BC and anastomosis displacements were modeled using Gaussian distributions according to prior research studies. By parameterizing the Fontan grafts, we built surrogate models of hemodynamic parameters taking the design parameters and BC as input. A two-phase reliability-based robust optimization (RBRO) strategy was developed by combining deterministic optimization (DO) and optimization under uncertainty (OUU) to reduce computational cost.
Results:
We evaluated the performance of the RBRO framework by comparing it with the DO method in four cases of Fontan patients. The results showed that the surgical plans computed from the proposed method yield up to 79.2% improvement in the reliability of the HFD than those of the DO method (
$p< 0.0001$
). The mean values of indexed power loss (iPL) and the percentage of non-physiologic wall shear stress (%WSS) for the optimized surgical plans met the clinically acceptable thresholds.
Conclusion:
This study demonstrated the effectiveness of our RBRO framework to address the uncertainties of BC and anastomosis displacements for Fontan surgical planning.
Significance:
The technique developed in this paper demonstrates a significant improvement in the reliability of the predicted post-operative outcomes for Fontan surgical planning. This planning technique is immediately applicable as a building block to enable technology for optimal long-term outcomes for pediatric Fontan patients and can also be used in other pediatric and adult cardiac surgeries.