Single Ventricle Assist Device: A Viable Option in Fontan Circulatory Failure

Abstract

<h3>Purpose</h3> Ventricular assist devices are increasingly being used for patients with single ventricle physiology. We describe the use of single ventricular assist device (SVAD) therapy in individuals with Fontan circulatory failure. <h3>Methods</h3> Retrospective, single center review of all patients with Fontan circulation implanted with an SVAD between 2016 and 2021. Patient characteristics and clinical outcomes were obtained by chart review. <h3>Results</h3> Seven patients underwent SVAD implantation between 2016 and 2021 (Table 1). Median age at implant was 25.3 (IQR 22.1-37.8) years; most had a lateral tunnel Fontan (71%), a systemic left ventricle (57%), and were implanted as a bridge to transplant candidacy. Concomitant surgical intervention at the time of SVAD implantation was common (Table 2). SVAD support continued for a median of 65 (IQR 39-283) days (d); 1 patient was successfully supported for 1105 d. Five patients had a positive outcome: 4 transplanted, 1 alive on device. One patient underwent combined heart-liver transplant. Of the 4 discharged home the median length of stay was 29 d and the median calculated VAD flow at discharge was 3.8 L/min/m². All 4 transplanted patients remain alive (median time since-transplant 713 d). The 2 deaths were due to multisystem organ failure. <h3>Conclusion</h3> SVAD support is a viable option for teenagers and young adults with Fontan circulatory failure despite the surgical complexity and challenging SVAD management (high calculated VAD flow). This suggests a role for advanced surgical modeling to optimize device positioning and highlights the need for continued multicenter collaboration to advance complex SVAD management strategies.