Faculty Collaboration Database

Systemic ventricular assist device support in Fontan patients: A report by ACTION. J Heart Lung Transplant 2021 May;40(5):368-376

Date

03/02/2021

Pubmed ID

33642140

DOI

10.1016/j.healun.2021.01.011

Scopus ID

2-s2.0-85101611141 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

BACKGROUND: The size of the Fontan population with end-stage heart failure is growing. In this population, heart transplantation has been the only option. This study sought to investigate the efficacy of ventricular assist device (VAD) support in Fontan patients.

METHODS: We conducted a retrospective study of Fontan patients in the Advanced Cardiac Therapies Improving Outcomes Network. We evaluated patient characteristics, and the clinical and physiologic outcomes after VAD implantation.

RESULTS: We identified 45 Fontan patients implanted with VAD. The average age of patients was 10 years (interquartile range: 4.5-18) and 30% were female. The majority had a morphologic right ventricle (69%), moderate or greater ventricular dysfunction (83%), and moderate or greater atrioventricular valve regurgitation (65%). The majority of implants were as a bridge to transplantation (76%), and the majority of patients were Interagency Registry for Mechanically Assisted Circulatory Support Profile 2 (56%). The most commonly employed device was the Medtronic HeartWare HVAD (56%). A total of 13 patients were discharged on device support, and 67% of patients experienced adverse events, the most common of which were neurologic (25%). At 1 year after device implantation, the rate of transplantation was 69.5%, 9.2% of patients continued to be VAD supported, and 21.3% of patients had died. Hemodynamically, VAD was effective in decreasing both Fontan and ventricular end-diastolic pressures in some individuals.

CONCLUSIONS: VAD is effective in supporting patients with end-stage Fontan failure awaiting heart transplantation. Future research should focus on identifying clinical and physiologic characteristics predictive of a favorable response to VAD support.

Author List

Cedars A, Kutty S, Danford D, Schumacher K, ACTION Learning Network Investigators, Auerbach SR, Bearl D, Chen S, Conway J, Dykes JC, Jaworski N, Joong A, Lorts A, Mascio CE, Morales DLS, Niebler RA, O'Connor M, Peng DM, Philip J, Reichman JR, Rosenthal DN, Zafar F, VanderPluym C, Villa C, Zinn M

Author

Robert Niebler MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Follow-Up Studies
Fontan Procedure
Heart Failure
Heart Transplantation
Heart-Assist Devices
Humans
Male
Registries
Retrospective Studies
Treatment Outcome