Systemic Ventricular Assist Device Support of the Fontan Circulation Yields Promising Outcomes: An Analysis of the STS Pedimacs and Intermacs Databases

Abstract Background Outcomes of ventricular assist device (VAD) support in patients with Fontan circulatory failure (or failing Fontan physiology) are largely unknown. Methods We conducted a retrospective analysis of patients with a Fontan circulation who underwent VAD implant in the Pedimacs and Intermacs databases from September 19, 2012 to December 31, 2019. Results We identified 55 Fontan patients who had undergone VAD implant with a median age at implantation of 10.2 years (Interquartile range, IQR, 6.4,16.9) and weight, 26.8 kg (IQR 17.7,53.8). More VADs were implanted in 2018-2019 than in 2012-2017 (28vs27, p=0.01). The later era had higher pre-VAD GFR (101.1±48.5 vs 71.2±34.9 p=0.02); 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 58% of mortality occurring in month one. Median length of support was 3.8 months (IQR 0.6, 6.9). 5 patients were supported for >1 year with no added mortality; the longest support time was 4 years, 7months. Adverse event rates included pump thrombosis incidence of 4% (3.3/100pt-mo), stroke 5.5% (1.4/100pt-mo), GI bleeding of 7% (2.6/100pt-mo), and non-GI bleeding of 9% (2.3/100pt-mo). Conclusion This is the largest reported analysis of systemic VAD support of Fontan patients. VAD support of the Fontan circulation is becoming more frequent. This analysis demonstrates that VAD use in this growing population can yield promising outcomes.