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Systemic ventricular assist device support in Fontan patients: A report by ACTION
- Source :
- The Journal of Heart and Lung Transplantation. 40:368-376
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- BACKGROUND The size of the Fontan population with end-stage heart failure is growing. In this population, heart transplantation has been the only option. This study sought to investigate the efficacy of ventricular assist device (VAD) support in Fontan patients. METHODS We conducted a retrospective study of Fontan patients in the Advanced Cardiac Therapies Improving Outcomes Network. We evaluated patient characteristics, and the clinical and physiologic outcomes after VAD implantation. RESULTS We identified 45 Fontan patients implanted with VAD. The average age of patients was 10 years (interquartile range: 4.5–18) and 30% were female. The majority had a morphologic right ventricle (69%), moderate or greater ventricular dysfunction (83%), and moderate or greater atrioventricular valve regurgitation (65%). The majority of implants were as a bridge to transplantation (76%), and the majority of patients were Interagency Registry for Mechanically Assisted Circulatory Support Profile 2 (56%). The most commonly employed device was the Medtronic HeartWare HVAD (56%). A total of 13 patients were discharged on device support, and 67% of patients experienced adverse events, the most common of which were neurologic (25%). At 1 year after device implantation, the rate of transplantation was 69.5%, 9.2% of patients continued to be VAD supported, and 21.3% of patients had died. Hemodynamically, VAD was effective in decreasing both Fontan and ventricular end-diastolic pressures in some individuals. CONCLUSIONS VAD is effective in supporting patients with end-stage Fontan failure awaiting heart transplantation. Future research should focus on identifying clinical and physiologic characteristics predictive of a favorable response to VAD support.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Population
030204 cardiovascular system & hematology
Fontan Procedure
03 medical and health sciences
0302 clinical medicine
Interquartile range
Internal medicine
medicine
Humans
Registries
cardiovascular diseases
Child
education
Retrospective Studies
Heart Failure
Heart transplantation
Transplantation
education.field_of_study
business.industry
Retrospective cohort study
medicine.disease
Treatment Outcome
medicine.anatomical_structure
030228 respiratory system
Ventricle
Child, Preschool
Ventricular assist device
Heart failure
Cardiology
Heart Transplantation
Female
Surgery
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 10532498
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- The Journal of Heart and Lung Transplantation
- Accession number :
- edsair.doi.dedup.....3dc7ea563b1acdf0d92b9f1a517ae6e7