Systemic ventricular assist device support of the Fontan circulation yields promising outcomes: An analysis of The Society of Thoracic Surgeons Pedimacs and Intermacs Databases

Case report: Heart Mate III for systemic right ventricular support in a patient with hypoplastic left heart syndrome

“…Over the last two decades, durable mechanical circulatory support advanced to a solid second-line treatment after heart transplantation for pediatric patients suffering from end-stage heart failure. With growing experience in the pediatric community, improving survival data and decline in adverse events, patients with failing Fontan circulation are increasingly considered suitable for VAD implantation ( 2 – 4 , 6 ). With the withdrawal of the HeartWare (Medtronic, Dublin, Ireland), the intracorporeal HM III and paracorporeal Berlin Heart EXCOR ® (Berlin Heart Medizintechnik GmbH, Berlin, Germany) remain the only options for pediatric durable support.…”

“…Improved surgical and medical management led to a growing adolescent and adult patient cohort with Fontan physiology, ultimately qualifying for heart transplantation. As donor organ availability remains scarce, we are now observing an upturn in Fontan patients undergoing durable ventricular assist device (VAD) implantation (2)(3)(4). Herein, we describe the clinical course of a 13-year-old male with hypoplastic left heart syndrome (HLHS), who suffered from refractory systolic and diastolic failure of the systemic ventricle with unimpaired pulmonary blood flow and consequently received a HeartMate 3 (Abbott, Chicago, IL, USA) as a bridge to transplant.…”

Narrative review of single ventricle: where are we after 40 years?

“… neonatal palliation, including Norwood Stage I  superior cavo-pulmonary shunt (bidirectional Glenn)  completion of Fontan circulation (early and late) Several reports are available on the indication and the type of mechanical circulatory support utilized for each stage (235)(236)(237)(238)(239)(240)(241).…”

“…Third, the availability of three main types of support devices must be considered: (I) veno-arterial extracorporeal membrane oxygenation, ideal for shortterm support; (II) ventricular assist device, for mid and long-term support (244), either as bridge to recovery or to transplantation; (III) total artificial heart (227)(228)(229)(230)(231)(232)(236)(237)(238)(239)(240)(241)(242). When planning to use a ventricular assist device, the differences among pulsatile, axial and centrifugal pumps, having different unloading abilities, must be taken in consideration (242,245).…”

Hypoplastic Left Heart Syndrome Across the Lifespan: Clinical Considerations for Care of the Fetus, Child, and Adult

“…Other techniques for managing failing Fontan physiology are emerging as new technologies for mechanical circulatory support are becoming available, and results with ventricular assist devices are encouraging at both pre-and post-Fontan stages. [124][125][126] Recent advances in computational flow dynamics and 4-dimensional magnetic resonance imaging have contributed to a deeper understanding of factors that contribute to energy losses in the Fontan circuit, and the translation of this technology is enabling optimised patient-specific Fontan design. [127][128][129][130] Insights from these technologies have also enabled design of more "futuristic" models of a Fontan circulation, including the possible incorporation of a pulsatile subpulmonary "neoventricle" from engineered heart tissue, thus providing additional energy to drive pulmonary blood flow as well as other devices designed to propel blood through the Fontan circuit.…”