Publications

Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update

Abstract

As the Fontan population grows, understanding successful strategies for ventricular assist device (VAD) support of the failing Fontan circulation is needed. We performed a retrospective analysis of patients with Fontan circulation and systemic VAD support in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. Competing outcomes and Kaplan–Meier estimated survival methods were used. Between January 2012 and December 2022, 106 Fontan patients underwent VAD implant (median age 10 years, 20% age ≥18 years). At time of implant, 58% were on greater than or equal to 2 inotropes, 26% on extracorporeal membrane oxygenation (ECMO), and 41% intubated. Since 2018, there have been more patients implanted at INTERMACS profile 1 or 2 (88% vs. 71%, p = 0.02) and on inotropic support (95% vs. 76%, p = 0.01). Median duration of VAD support was 113 (interquartile range (IQR): 43–266) days. At 12 months post-VAD implant, 53% were transplanted, 27% were alive on device, 2% had successful recovery, and 18% had died. Overall, 75% experienced greater than or equal to 1 adverse event, with bleeding, infection, and neurologic dysfunction most common. Despite high acuity at the time of VAD implant and high rate of adverse events, the majority of Fontan patients were transplanted or still alive on device at 12 months post-VAD implant.

This ACTION study was available in the ASAIO Journal on December 27, 2024. Congratulations to the authors:

  • Sharon Chen
  • Kathleen E. Simpson
  • ACTION Learning Network Investigators (Iki Adachi, Shahnawaz Amdani, Neha Bansal, David W. Bearl, Mark Bleiweis, Umar Boston, Chesney Castleberry, Ari Cedars, Jennifer Conway, Ryan Davies, John Dykes, Anna Joong, Sabrina Law, Katsuhide Maeda, Chad Mao, Lindsay May, Angela Lorts, David Morales, Matthew O’Connor, F. Bennet Pearce, Kurt Schumacher, Muhammad F. Shezad, Svetlana B. Shugh, Nikki M. Singh, Joseph Spinner, Jennifer A. Su, David L. Sutcliffe, Christina VanderPluym, Megan Wilde, Aecha Ybarra, Steven Zangwill, Matthew Zinn)
CITATION

Chen, Sharon; Simpson, Kathleen E.; on Behalf of ACTION Learning Network Investigators. Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update. ASAIO Journal December 27, 2024. | DOI: 10.1097/MAT.0000000000002367