VAD Support of the Fontan Circulation: An Analysis of the STS Pedimacs and Intermacs Databases

Purpose Ventricular assist device (VAD) use in patients with congenital heart disease continues to increase. However, the outcomes of supporting a Fontan circulation with a VAD are largely unknown. Methods This is a retrospective review of the Pedimacs and Intermacs databases. 55 patients underwent systemic VAD implant to support the Fontan circulation between September 2012 and December 2019. Results The mean age of patients at implantation was 12.2 ± 8.0 yrs, and mean weight, 38.1 ± 26.8 kgs. Patient demographics are presented in Table 1. 28 more VADs were implanted in 2018-2019 than in 2012-2017 (28 vs 27, P = 0.007, Figure 1). The later era had higher GFR (101.1 ± 48.5 vs 71.2 ± 34.9 P = 0.02) and were more likely being followed for heart failure prior to VAD (96% vs 74% P = 0.02), but there was no difference in INTERMACS profile (P = 0.69). Kaplan-Meier survival on device was 76% at 6 months with no difference by era. Competing outcomes demonstrated a positive outcome of 81% (alive on VAD, transplanted or recovered) at 6 months, with the majority of mortality occurring in month one. Mean length of support was 5.5 ± 8 mos. 5 patients were supported for \u003e1 yr with no added mortality; the longest support time was 4 yrs 7mos. Adverse event rates included pump thrombosis incidence of 4% (3.3/100 pt-mo), GI bleeding of 7% (2.6/100 pt-mo), and non-GI bleeding of 9% (2.3/100 pt-mo). Freedom from stroke and infection were both 95% at 6 months. Conclusion This is the largest reported analysis of systemic VAD support of Fontan patients. Mechanical circulatory support of the Fontan circulation is increasing in prevalence and can be performed with promising outcomes.