Transplantation and Arch Repair in Fontan 3 Years After HeartMate 3: Technical Considerations

We previously reported the first successful implantation of the HeartMate 3 (Abbott Laboratories) in a Fontan patient. We now report his successful transplantation after 1104 days of support, the longest reported bridge to transplant of a Fontan patient. We describe our operative technique complicated by not only the Fontan anatomy and ventricular assist device but also by a >10-cm ascending and aortic arch aneurysm. Additionally the posttransplant hemodynamics of this patient appeared to demonstrate that effective ventricular assist device support may induce reversal of chronic effects of the failing Fontan circulation, which in this case was the elimination of his aortopulmonary collateral burden.