{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:40:56Z","timestamp":1785436856162,"version":"3.56.0"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010629","name":"Fulbright Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010629","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Infants with single\u2010ventricle (SV) physiology undergo the 3\u2010stage Fontan surgery. Norwood patients, who have completed the first stage, face the highest interstage mortality. The Berlin Heart EXCOR (BH), a pediatric pulsatile ventricular assist device, has shown promise in supporting these patients. However, clinical questions regarding device configurations prevent optimal support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed a combined idealized mechanics\u2010lumped parameter model of a Norwood patient and simulated two additional patient\u2010specific cases: pulmonary hypertension (PH) and post\u2010operative treatment with milrinone. We quantified the effects of BH support across different device volumes, rates, and inflow connections on patient hemodynamics and BH performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Increasing device volume and rate increased cardiac output, but with unsubstantial changes in specific arterial oxygen content. We identified distinct SV\u2013BH interactions that may impact patient myocardial health and contribute to poor clinical outcomes. Our results suggested BH settings for patients with PH and for patients treated post\u2010operatively with milrinone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We present a computational model to characterize and quantify patient hemodynamics and BH support for infants with Norwood physiology. Our results emphasized that oxygen delivery does not increase with BH rate or volume, which may not meet patient needs and contribute to suboptimal clinical outcomes. Our findings demonstrated that an atrial BH may provide optimal cardiac loading for patients with diastolic dysfunction. Meanwhile, a ventricular BH decreased active stress in the myocardium and countered the effects of milrinone. Patients with PH showed greater sensitivity to device volume. In this work, we demonstrate the adaptability of our model to analyze BH support across varied clinical situations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14544","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T10:04:37Z","timestamp":1681293877000},"page":"1133-1150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Investigating the hemodynamics of Berlin Heart <scp>EXCOR<\/scp> support in Norwood patients across diverse clinical scenarios with computational modeling"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9411-5233","authenticated-orcid":false,"given":"Victoria","family":"Yuan","sequence":"first","affiliation":[{"name":"David Geffen School of Medicine at UCLA  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7597-020X","authenticated-orcid":false,"given":"Francesco","family":"De\u00a0Gaetano","sequence":"additional","affiliation":[{"name":"Chemistry, Materials and Chemical Engineering Department \u201cGiulio Natta\u201d Politecnico di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasra","family":"Osouli","sequence":"additional","affiliation":[{"name":"Chemistry, Materials and Chemical Engineering Department \u201cGiulio Natta\u201d Politecnico di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison L.","family":"Marsden","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Bioengineering Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6974-2692","authenticated-orcid":false,"given":"Maria Laura","family":"Costantino","sequence":"additional","affiliation":[{"name":"Chemistry, Materials and Chemical Engineering Department \u201cGiulio Natta\u201d Politecnico di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(02)00198-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000685"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2021.05.045"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.10.030"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2015.02.002"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-022-02818-y"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.05.100"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2011.01403.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezw011"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e3182396847"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.2001.280.5.H2076"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.010769"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.04.047"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4006814"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-010-9978-5"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2009.00940.x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mat.0000176169.73987.0d"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/10255842.2015.1062478"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.12591"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2018.00115"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-021-00603-1"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2015.11.030"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/cnm.1466"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.09.022"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000198626.67391.34"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(03)01315-1"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.679654"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199511000-00018"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vascn.2018.06.001"},{"key":"e_1_2_8_31_1","unstructured":"GmbH 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