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. 2025 Jul 1;71(7):588-595.
doi: 10.1097/MAT.0000000000002367. Epub 2024 Dec 26.

Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update

Sharon Chen  1 , Kathleen E Simpson  2 ; ACTION Learning Network Investigators
Collaborators, Affiliations

Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update

Sharon Chen et al. ASAIO J. .

Abstract

As the Fontan population grows, understanding successful strategies for ventricular assist device (VAD) support of the failing Fontan circulation is needed. We performed a retrospective analysis of patients with Fontan circulation and systemic VAD support in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. Competing outcomes and Kaplan-Meier estimated survival methods were used. Between January 2012 and December 2022, 106 Fontan patients underwent VAD implant (median age 10 years, 20% age ≥18 years). At time of implant, 58% were on greater than or equal to 2 inotropes, 26% on extracorporeal membrane oxygenation (ECMO), and 41% intubated. Since 2018, there have been more patients implanted at INTERMACS profile 1 or 2 (88% vs . 71%, p = 0.02) and on inotropic support (95% vs . 76%, p = 0.01). Median duration of VAD support was 113 (interquartile range (IQR): 43-266) days. At 12 months post-VAD implant, 53% were transplanted, 27% were alive on device, 2% had successful recovery, and 18% had died. Overall, 75% experienced greater than or equal to 1 adverse event, with bleeding, infection, and neurologic dysfunction most common. Despite high acuity at the time of VAD implant and high rate of adverse events, the majority of Fontan patients were transplanted or still alive on device at 12 months post-VAD implant.

Keywords: Fontan; VAD; single ventricle.

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Conflict of interest statement

Disclosure: Svetlana B. Shugh is a member of the Abiomed Pediatric Advisory Board; Angela Lorts and David Morales are a consultant for Abbott, SynCardia, and Berlin Heart; Katsuhide Maeda is a consultant for Abiomed, Abbott, and Berlin Heart. The other authors have no conflicts of interest to report.

References

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    1. Atz AM, Zak V, Mahony L, et al.; Pediatric Heart Network Investigators: Longitudinal outcomes of patients with single ventricle after the Fontan procedure. J Am Coll Cardiol. 69: 2735–2744, 2017.

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