Ventricular assist device for Fontan: who, when and why?

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Fontan palliation has improved survival for univentricular congenital heart disease patients.
• These patients often develop end-stage heart failure, necessitating advanced therapies.
• Heart transplantation wait times make mechanical circulatory support (MCS) an important alternative.

Purpose of the Study:

• To review current strategies for selecting patients for ventricular assist device (VAD) implantation.
• To discuss the optimal timing for VAD implantation in Fontan patients.
• To outline considerations for device selection in this population.

Main Methods:

• Review of existing literature and case reports on VAD implantation in Fontan patients.
• Analysis of outcomes based on patient characteristics and clinical status.
• Synthesis of current expert opinion on patient selection and device choice.

Main Results:

• VAD implantation in end-stage Fontan patients is emerging, with increasing research interest.
• Mortality rates are higher compared to non-congenital heart disease populations.
• Implantation is indicated for systolic dysfunction; single VAD may not suit those with high transpulmonary gradients.
• Optimal timing is before clinical decompensation and end-organ damage.

Conclusions:

• Fontan patients with heart failure require early and frequent evaluation for VAD candidacy and timing.
• VAD implantation in this cohort is expected to increase significantly.
• Careful patient selection and timing are paramount for successful VAD therapy.