TY - JOUR
T1 - Systemic ventricular assist device support in Fontan patients
T2 - A report by ACTION
AU - ACTION Learning Network Investigators:
AU - Cedars, Ari
AU - Kutty, Shelby
AU - Danford, David
AU - Schumacher, Kurt
AU - Auerbach, S. R.
AU - Bearl, D.
AU - Chen, S.
AU - Conway, J.
AU - Dykes, J. C.
AU - Jaworski, N.
AU - Joong, A.
AU - Lorts, A.
AU - Mascio, C. E.
AU - Morales, D. L.S.
AU - Niebler, R. A.
AU - O'Connor, M.
AU - Peng, D. M.
AU - Philip, J.
AU - Reichman, J. R.
AU - Rosenthal, D. N.
AU - Zafar, F.
AU - VanderPluym, C.
AU - Villa, C.
AU - Zinn, M.
N1 - Publisher Copyright:
© 2021 International Society for Heart and Lung Transplantation
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Fontan
KW - congenital heart disease
KW - end-stage heart failure
KW - mechanical circulatory support
KW - ventricular assist device
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U2 - 10.1016/j.healun.2021.01.011
DO - 10.1016/j.healun.2021.01.011
M3 - Article
C2 - 33642140
AN - SCOPUS:85101611141
SN - 1053-2498
VL - 40
SP - 368
EP - 376
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 5
ER -