Promising Outcomes: Supporting Fontan Patients With Systemic Ventricular Assist Device Therapy
Spencer J. Hogue, BS, Kevin Kulshrestha, MD, MBE, Angela Lorts, MD, MBA, Tanya Perry, DO, Katrina Fields, RN, Chet Villa, MD, David G. Lehenbauer, MD, David L. S. Morales, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objectives: Single ventricular assist devices (SVAD) have emerged as a promising therapy for Fontan patients with failing circulation. Therefore, we analyzed our institution's Fontan SVAD experience to highlight outcomes in this cohort.
Methods: All Fontan patients that underwent SVAD implantation at our institution from 2016-2023 were retrospectively reviewed.
Results: Twelve patients were included, predominantly consisting of patients with a HLHS diagnosis (67%, n=8). All patients were palliated with extracardiac conduit (58%, n=7) or lateral tunnel (42%, n=5) Fontan circulations. SVAD implantation occurred at a median of 9.5 [IQR:2.3-23.3] years post-Fontan. Temporary SVAD exchange to durable support occurred in three (25%) patients. All patients except one (n=11) were ensured to have a fenestration. A majority of SVADs were purposed for bridging patients to transplant candidacy (58%, n=7). The median duration of SVAD support and hospital length of stay were 104 [IQR:39-546] and 37 [IQR:24-137] days, respectively. Two (17%) patients remain supported and two (17%) in-hospital mortalities occurred at 11 and 52 days post-SVAD; these patients were ≥37 years old. Eight (67%) patients received a heart (n=7) or en-bloc heart-liver (n=1) transplant. The median follow-up was 2.6 [IQR:1.6-3.7] years. For the overall cohort, the in-hospital, one-, and three-year survivals were 83%. (Table)
Conclusions: Though Fontan failure remains a challenging physiologic state, this series demonstrates promising results, supporting that these patients can be effectively managed with SVAD therapy.
| Demographics | |
| Male sex | 9 (75%) |
| White race | 8 (67%) |
| Age (years) | 23.8 [IQR 13.3-30.9] |
| Weight (kg) | 69.9 [IQR 39.7-73.3] |
| Primary Cardiac Diagnoses | |
| Hypoplastic Left Heart Syndrome | 8 (67%) |
| Tricuspid Atresia | 2 (17%) |
| Double Outlet Left Ventricle | 1 (8%) |
| Double Inlet Left Ventricle | 1 (8%) |
| SVAD Implant | |
| SVAD Support Duration (days) | 104 [IQR 39-546] |
| Performed with no CPB (EXCORs) | 2 (17%) |
| Durable SVAD Types | |
| HeartMate 3 | 9 (75%) |
| Berlin Heart EXCOR | 2 (17%) |
| Heartware | 1 (8%) |
| Temporary SVAD Types | |
| Median Support Duration (days) | 3.5 [IQR 3.0-5.5] |
| Centrimag | 2 (17%) |
| Impella | 1 (8%) |
| SVAD Purpose | |
| Bridge to Transplant | 4 (33%) |
| Bridge to Transplant Candidacy | 7 (58%) |
| Bridge to Recovery | 1 (8%) |
| Concomitant Procedures | |
| Fontan Conduit Fenestration | 6 (50%) |
| Fontan Revision | 2 (17%) |
| Aortic Valve Repair | 1 (8%) |
| Mitral Valve Repair | 1 (8%) |
| Carotid Artery Repair | 1 (8%) |
| Damus-Kaye-Stansel Takedown | 1 (8%) |
| In-hospital Re-interventions | 3 Patients (35%) |
| Mediastinal Hematoma Evacuation | 2 (17%) |
| SVAD Repositioning | 2 (17%) |
| Oxygenator Placement | 1 (8%) |
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