Systemic ventricular assist device support of the Fontan circulation yields promising outcomes: An analysis of The Society of Thoracic Surgeons Pedimacs and Intermacs Databases

Abstract

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.

Keywords: Fontan; congenital; heart failure; mechanical circulatory support; transplantation; ventricular assist device.