Systemic VAD Support in Fontan Patients

Fontan patients are at risk for developing significant heart failure. This retrospective study investigates the efficacy of VAD support in 45 Fontan patients—the first Fontan multi-center cohort from ACTION centers: “Systemic ventricular assist device support in Fontan patients: A report by ACTION.” It was published in The Journal of Heart and Lung Transplantation on January 19, 2021. Researchers evaluated the patient characteristics and the clinical and physiologic outcomes after VAD implantation.

Key Findings:
  • Bridge to transplantation was most common use for VAD implant (76%)
  • HVAD™ System was the most commonly used device (56%)
  • Thirteen patients were discharged while on VAD support
  • Adverse events occurred in 67% of patients, and the most common AEs were neurologic (25%)
  • At 1 year, the rate of transplantation was 69.5%, 9.2% of patients continued to be VAD supported, and 21.3% of patients had passed away
  • Hemodynamically, VAD support was effective in decreasing both Fontan and ventricular end-diastolic pressures in some individuals

This study concluded that VADs can effectively support patients with end-stage Fontan failure awaiting heart transplantation and longer term support. More data is needed around clinical and physiologic characteristics predictive of a favorable response to VAD support.

Special shoutout to the ACTION leaders who collaborated on this publication to demonstrate what they know about VAD in Fontan:

  • Ari Cedars, Johns Hopkins Children’s Center
  • Kurt Schumacher, C.S. Mott Children’s Hospital
  • Scott Auerbach, Children’s Hospital Colorado
  • Jennifer Conway, Stollery Children’s Hospital
  • John Dykes, Lucile Packard Children’s Hospital
  • Anna Joong, Lurie Children’s Hospital of Chicago
  • Angela Lorts, Cincinnati Children’s Hospital Medical Center
  • David Morales, Cincinnati Children’s Hospital Medical Center
  • Rob Niebler, Children’s Hospital of Wisconsin
  • Matthew O’Connor, Children’s Hospital of Philadelphia
  • David Peng, C.S. Mott Children’s Hospital

Cedars A, Kutty S, Danford D, Schumacher K, Auerbach SR, Bearl D, Chen S, Conway J, Dykes JC, Jaworski N, Joong A, Lorts A, Mascio CE, Morales DLS, Niebler RA, O’Connor M, Peng DM, Philip J, Reichman JR, Rosenthal DN, Zafar F, VanderPluym C, Villa C, Zinn M; ACTION Learning Network Investigators:. Systemic ventricular assist device support in Fontan patients: A report by ACTION. J Heart Lung Transplant. 2021 Jan 19:S1053-2498(21)00025-5. doi: 10.1016/j.healun.2021.01.011. Epub ahead of print. PMID: 33642140.