{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:32:12Z","timestamp":1776231132039,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010663","name":"European Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Proof of Concept Grant BloodTurbine, ERC Starting","award":["307460"],"award-info":[{"award-number":["307460"]}]},{"name":"TUBITAK 1003","award":["115E690"],"award-info":[{"award-number":["115E690"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>For 9 patients, aged 2 to18\u2009years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Date and number of IRB approval<\/jats:title>\n                  <jats:p>25 October 2019, 280011928-604.01.01.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivac001","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T20:10:42Z","timestamp":1642191042000},"page":"1095-1105","source":"Crossref","is-referenced-by-count":11,"title":["A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation"],"prefix":"10.1093","volume":"34","author":[{"given":"S Samaneh","family":"Lashkarinia","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Koc University , Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Cicek","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital , Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1766-2778","authenticated-orcid":false,"given":"Banu","family":"Kose","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Istanbul Medipol University , Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0539-1616","authenticated-orcid":false,"given":"Mohammad","family":"Rezaeimoghaddam","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Koc University , Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emine 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