TY - JOUR
T1 - Systemic ventricular assist device support of the Fontan circulation yields promising outcomes
T2 - An analysis of The Society of Thoracic Surgeons Pedimacs and Intermacs Databases
AU - Society of Thoracic Surgeons Fontan VAD Group
AU - Bedzra, Edo K.S.
AU - Adachi, Iki
AU - Peng, David M.
AU - Amdani, Shahnawaz
AU - Jacobs, Jeffrey P.
AU - Koehl, Devin
AU - Cedars, Ari
AU - Morales, David L.
AU - Maeda, Katsuhide
AU - Naka, Yoshifumi
AU - Lorts, Angela
AU - Law, Sabrina
AU - Cantor, Ryan
N1 - Funding Information:
The authors thank Alan O'Donnell, PA-C, for creating the accompanying video. In addition to the authors, The Society of Thoracic Surgeons Fontan VAD Group additional members include Katsuhide Maeda, MD, Cardiac Surgery, Children's Hospital of Pennsylvania, Philadelphia, Pa; Yoshifumi Naka, MD, Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; Angela Lorts, MD, Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Sabrina Law, MD, Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY; and Ryan Cantor, PhD, James and John Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala.
Publisher Copyright:
© 2021 The American Association for Thoracic Surgery
PY - 2022/8
Y1 - 2022/8
N2 - Background: Outcomes of ventricular assist device (VAD) support in patients with Fontan circulatory failure (or failing Fontan physiology) are largely unknown. Methods: We conducted a retrospective analysis of patients with a Fontan circulation who underwent VAD implant in the Society of Thoracic Surgeons Pedimacs and Intermacs Databases from September 19, 2012, to December 31, 2019. Results: We identified 55 Fontan patients who had undergone VAD implant with a median age at implantation of 10.2 years (interquartile range, 6.4-16.9 years) and weight, 26.8 kg (interquartile range, 17.7-53.8 years). More VADs were implanted in 2018-2019 than in 2012-2017 (28 vs 27; P = .01). The later era had higher pre-VAD glomerular filtration rate (101.1 ± 48.5 vs 71.2 ± 34.9; P = .02); there was no difference in Interagency Registry for Mechanically Assisted Circulatory Support profile (P = .69). Kaplan-Meier survival on device was 76% at 6 months with no difference by era. Competing outcomes demonstrated a positive outcome of 81% (alive on VAD, transplanted, or recovered) at 6 months, with 58% of mortality occurring during month 1. Median length of support was 3.8 months (interquartile range, 0.6-6.9 months). Five patients were supported for >1 year with no added mortality; the longest support time was 4 years, 7 months. Adverse event rates included pump thrombosis incidence of 4% (3.3 out of 100 patient-months), stroke 5.5% (1.4 out of 100 patient-months), gastrointestinal bleeding of 7% (2.6 out of 100 patient-months), and nongastrointestinal bleeding of 9% (2.3 out of 100 patient-months). Conclusions: This is the largest reported analysis of systemic VAD support of Fontan patients. VAD support of the Fontan circulation is becoming more frequent. This analysis demonstrates that VAD use in this growing population can yield promising outcomes.
AB - Background: Outcomes of ventricular assist device (VAD) support in patients with Fontan circulatory failure (or failing Fontan physiology) are largely unknown. Methods: We conducted a retrospective analysis of patients with a Fontan circulation who underwent VAD implant in the Society of Thoracic Surgeons Pedimacs and Intermacs Databases from September 19, 2012, to December 31, 2019. Results: We identified 55 Fontan patients who had undergone VAD implant with a median age at implantation of 10.2 years (interquartile range, 6.4-16.9 years) and weight, 26.8 kg (interquartile range, 17.7-53.8 years). More VADs were implanted in 2018-2019 than in 2012-2017 (28 vs 27; P = .01). The later era had higher pre-VAD glomerular filtration rate (101.1 ± 48.5 vs 71.2 ± 34.9; P = .02); there was no difference in Interagency Registry for Mechanically Assisted Circulatory Support profile (P = .69). Kaplan-Meier survival on device was 76% at 6 months with no difference by era. Competing outcomes demonstrated a positive outcome of 81% (alive on VAD, transplanted, or recovered) at 6 months, with 58% of mortality occurring during month 1. Median length of support was 3.8 months (interquartile range, 0.6-6.9 months). Five patients were supported for >1 year with no added mortality; the longest support time was 4 years, 7 months. Adverse event rates included pump thrombosis incidence of 4% (3.3 out of 100 patient-months), stroke 5.5% (1.4 out of 100 patient-months), gastrointestinal bleeding of 7% (2.6 out of 100 patient-months), and nongastrointestinal bleeding of 9% (2.3 out of 100 patient-months). Conclusions: This is the largest reported analysis of systemic VAD support of Fontan patients. VAD support of the Fontan circulation is becoming more frequent. This analysis demonstrates that VAD use in this growing population can yield promising outcomes.
KW - Fontan
KW - congenital
KW - heart failure
KW - mechanical circulatory support
KW - transplantation
KW - ventricular assist device
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U2 - 10.1016/j.jtcvs.2021.11.054
DO - 10.1016/j.jtcvs.2021.11.054
M3 - Article
C2 - 35016782
AN - SCOPUS:85122513979
SN - 0022-5223
VL - 164
SP - 353
EP - 364
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -