Purpose-Built Transcatheter Cavopulmonary Anastomosis Device Requirements: Multi-Modality Imaging Evaluation

Background/purpose: Patients with a functional single ventricle undergo multiple, palliative open-heart surgeries. This includes a superior cavopulmonary anastomosis or bidirectional Glenn shunt. A less-invasive transcatheter approach may reduce morbidity. Methods/materials: We analyzed pre-Glenn X-ray contrast angiography (XA), cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) studies. Results: Over an eleven-year period (1/2007 - 6/2017), 139 Glenn surgeries were performed at our institution. The typical age range at surgery was 59 - 371 days (median = 163; IQR = 138 - 203). Eight-nine XA, ten CT, and ten CMR studies obtained from these patients were analyzed. Cephalad SVC measurements (millimeters) were 7.3 +/- 1.7 (XA), 7.7 +/- 1.6 (CT) and 6.9 +/- 1.8 (CMR). RPA measurements were 7.3 +/- 1.9 (XA), 7.4 +/- 1.6 (CT) and 6.6 +/- 1.9 (CMR). Potential device lengths were 10.9 +/- 6 - 17.4 +/- 6.4 (XA), 10.1 +/- 2.1 - 17.7 +/- 2.4 (CT) and 17.3 +/- 4. - 23.7 +/- 5.5 (CMR). SVC-RPA angle (degrees) was 132.9 +/- 13.2 (CT) and 140 +/- 10.2 (MRI). Image quality of all CT (100%), almost all XA (SVC 100%, RPA 99%), and most MRI (SVC 80%, RPA 90%) were deemed sufficient. Parametric modeling virtual fit device with 10 mm diameter and 20 - 25 mm length was ideal. Conclusions: Ideal transcatheter cavopulmonary shunt device for the typical patient would be 10 mm in diameter and 20-25 mm in length.