- What does clay have to do with computational flow dynamics (CFD) and the personalized Fontan (herein referred to as the TCPC)? Loke and colleagues' response1 is that a surgeon-fashioned clay TCPC actually performed reasonably well and could reduce the computational time and money by serving as starting input for the CFD iterative process. With the availability of surgical modeling software, we don't fully understand the need for clay and haptic feedback but, must admit, find the use of clay kind of appealing—can't explain it, maybe it invokes pleasant childhood memories.
- I congratulate Yeung and colleagues1 for their development of an elegant, sophisticated, and innovative technology and also commend their collaboration across multiple disciplines and institutions. The basic concept they promote is intuitively very appealing—use patient-specific anatomy, guided by computational fluid dynamics, to develop 3-dimensional (3D) vascular grafts tailored to a given patient's specific needs—in this particular case, the creation of bifurcated pulmonary artery grafts. The reader should look beyond the fact that both animals originally had normal anatomy, as I presume the computer-aided design phase would permit creation of any desired anatomy (for missing parts), which could then be modified to fit the patient's true anatomy.
- Surgeons loathe endocarditis—it kills patients and causes morbidity. Moreover, nothing puts a damper on a surgeon's day like a multiple redo sternotomy and inadvertent rupture of an endocarditic conduit. Therefore, the report by Beckerman and colleagues1 of increased risk of infective endocarditis (IE) with bovine jugular vein (BJV) conduits (Medtronic Inc, Minneapolis, Minn), which is a notable addition to the growing literature on this topic, is certainly concerning. At a median follow-up of 7.5 years, IE occurred in 10% of 253 BJV conduits, 0.8% of 506 homografts, and 1.9% of 269 porcine heterografts.