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Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
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Failing Fontan cardiovascular support: Review

Joseph B Zwischenberger1, Katherine A Breetz2, Cherry Ballard-Croft3

  • 1Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA.

Journal of Cardiac Surgery
|November 2, 2022
PubMed

Insights

Support for failing Fontan circulation is crucial. Various mechanical circulatory support devices offer a bridge to heart transplantation, aiming to reduce morbidity and mortality in patients with univentricular congenital heart defects.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiovascular Surgery

Background:

  • Univentricular congenital heart defects (CHD) pose unique challenges in passive pulmonary blood flow perfusion.
  • The Fontan circulation, a three-stage surgical palliation, connects the inferior vena cava to the pulmonary artery for passive venous return.
  • This complex physiology requires low pulmonary resistance to maintain adequate forward flow, often leading to eventual failure.

Purpose of the Study:

  • To review and evaluate different techniques for supporting a failing Fontan circulation.
  • To identify innovative mechanical circulatory support strategies as a bridge to heart transplantation.
  • To analyze the strengths and weaknesses of various technologies in the context of Fontan physiology.

Main Methods:

  • Literature review of PubMed, Google Scholar, and the University of Kentucky library.
  • Focused search on techniques evaluated to support failing Fontan circulation.
  • Analysis of existing data on extracorporeal membrane oxygenation, ventricular assist devices, and total artificial hearts.

Main Results:

  • Multiple technologies, including ECMO, VADs, and TAHs, have been explored to support failing Fontan circulations.
  • These devices have shown varying degrees of success in laboratory settings and clinicalFontan patients.
  • The study highlights the specific advantages and disadvantages of each technology for Fontan physiology.

Conclusions:

  • Heart transplantation remains the ultimate goal for patients with failing Fontan circulation.
  • Mechanical circulatory support devices serve as a critical bridge to transplant, mitigating morbidity and mortality.
  • Limited donor heart availability necessitates the optimization of these temporary support strategies.
Abstract

Keywords:
Fontan circulationcongenital heart defects (CHD)extracorporeal membrane oxygenation (ECMO)total artificial heart (TAH)ventricular assist devices (VAD)

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