Mechanical support for the failing single ventricle after Fontan

Abstract

Central MessageChildren with failing Fontan circulation, particularly those with predominant systolic dysfunction, can benefit from early consideration for VAD placement.Feature Editor's Note—The rapidly growing population of patients with failing Fontan circulation brings new challenges to our specialty. As we all learned in the recent years, medical management alone of patients with failing Fontan circulation is often inadequate. Many patients with single-ventricle physiology eventually develop failure of the univentricular circulation and require heart transplantation. Mechanical support of the failing single ventricle after the Fontan operation is complex and demands utmost attention to detail. A group of leading experts from Cincinnati Children's Hospital share their views on and discuss their approach to mechanical support of patients with failing Fontan circulation.Igor E. Konstantinov, MD, PhD, FRACSThe 4 decades after the development of the Fontan procedure have seen serial improvements in the surgical and clinical care for children with single-ventricle physiology.1Fontan F. Baudet E. Surgical repair of tricuspid atresia.Thorax. 1971; 26: 240-248Crossref PubMed have and is for the to after the Fontan in the of patients with single ventricle after the Fontan PubMed and in the PubMed in and after the Fontan PubMed after the Fontan of single PubMed those Fontan patients to to and to in and after the Fontan PubMed in the and is is to heart failure those the Fontan with and systolic dysfunction, to to the and with VAD in the and for and to for VAD the of on the of clinical and early and for patients for in for after have of early after VAD for mechanical support PubMed of on the of patients PubMed of PubMed have patients with heart for VAD and heart patients in with heart for heart of PubMed of mechanical support in with heart of the for support PubMed to for with heart of the for PubMed and in heart patients with from to PubMed can in of mechanical support in with heart of the for support PubMed F. for heart patients with PubMed is the in for patients with and systolic approach the of and benefit from to the for VAD the for of after the Fontan of and PubMed and management of the and with Fontan from the approach and and VAD approach in with to for have to to on the for in the of for of for of heart failure to heart failure with of the of on PubMed in the the for VAD have VAD in the in of of and the our the is rapidly for in the of systolic the Fontan circulation from the dysfunction, and systolic and and is to the of and to surgical and approach the of from the circulation to the ventricle VAD is in the to Fontan with and the in the of to and is to clinical and benefit from VAD is to and to and of after the Fontan procedure PubMed of with to patients benefit from to approach and benefit from VAD and to the on in the Fontan after the of we often to with management and to As in the of Fontan patients to the of in patients with heart and PubMed and with and for VAD with Fontan and to for the and of and is for to of and can of with require to the is VAD 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and VAD and VAD is in Fontan patients to of and early and to the of the often the Fontan circulation, is of the failing Fontan in PubMed VAD and in patients on and early is can to the for to the require to the care can in we have for the of our the with the we on the of of with the of in with to and we have in those with VAD to and the of A approach is the and for Fontan of to with VAD and with of to and is often of 4 with on the of the we have with our patients the we to the the management is early and of the of the clinical and of patients on support for our we the clinical their clinical and clinical of the our and clinical the is with and of in clinical and care care heart heart of the in have seen the of VAD in the failing Fontan is of the of patients with the VAD can in and with the from VAD support can Fontan VAD physiology of patients on to of patients of patients of in patients on the of the and with of the the the of to VAD Many Fontan and is and the of the for Fontan VAD is Fontan failure is to systolic with and benefit the is and predominant dysfunction, the to and to VAD in the Fontan circulation, approach from the for and support of the Fontan of the and from and and and is in the the Fontan with predominant systolic patients have of Fontan failure and benefit from VAD As the VAD to approach Fontan and is in patients of is for and and of the for and of and to of and to for have of and of have of with failing Fontan circulation, particularly those with predominant systolic dysfunction, can benefit from early consideration for VAD with failing Fontan circulation, particularly those with predominant systolic dysfunction, can benefit from early consideration for VAD Editor's Note—The rapidly growing population of patients with failing Fontan circulation brings new challenges to our specialty. As we all learned in the recent years, medical management alone of patients with failing Fontan circulation is often inadequate. Many patients with single-ventricle physiology eventually develop failure of the univentricular circulation and require heart transplantation. Mechanical support of the failing single ventricle after the Fontan operation is complex and demands utmost attention to detail. A group of leading experts from Cincinnati Children's Hospital share their views on and discuss their approach to mechanical support of patients with failing Fontan E. Konstantinov, MD, PhD, 4 decades after the development of the Fontan procedure have seen serial improvements in the surgical and clinical care for children with single-ventricle physiology.1Fontan F. Baudet E. Surgical repair of tricuspid atresia.Thorax. 1971; 26: 240-248Crossref PubMed have and is for the to after the Fontan in the of patients with single ventricle after the Fontan PubMed and in the PubMed in and after the Fontan PubMed after the Fontan of single PubMed those Fontan patients to to and to in and after the Fontan PubMed in the and is is to heart failure those the Fontan with and systolic dysfunction, to to the and with VAD in the and for and to for VAD the of on the of clinical and early and for patients for in for after have of early after VAD for mechanical support PubMed of on the of patients PubMed of PubMed have patients with heart for VAD and heart patients in with heart for heart of PubMed of mechanical support in with heart of the for support PubMed to for with heart of the for PubMed and in heart patients with from to PubMed can in of mechanical support in with heart of the for support PubMed F. for heart patients with PubMed is the in for patients with and systolic approach the of and benefit from to the for VAD the for of after the Fontan of and PubMed and management of the and with Fontan from the approach and and VAD approach in with to for have to to on the for in the of for of for of heart failure to heart failure with of the of on PubMed in the the for VAD have VAD in the in of of and the our the is rapidly and to for VAD the of on the of clinical and early and for patients for in for after have of early after VAD for mechanical support PubMed of on the of patients PubMed of PubMed have patients with heart for VAD and heart patients in with heart for heart of PubMed of mechanical support in with heart of the for support PubMed to for with heart of the for PubMed and in heart patients with from to PubMed can in of mechanical support in with heart of the for support PubMed F. for heart patients with PubMed is the in for patients with and systolic approach the of and benefit from to the for VAD the for of after the Fontan of and PubMed and management of the and with Fontan from the approach and and VAD approach in with to for have to to on the for in the of for of for of heart failure to heart failure with of the of on PubMed in the the for VAD have VAD in the in of of and the our the is rapidly for in the of systolic the Fontan circulation from the dysfunction, and systolic and and is to the of and to surgical and approach the of from the circulation to the ventricle VAD is in the to Fontan with and the in the of to and is to clinical and benefit from VAD is to and to and of after the Fontan procedure PubMed of with to patients benefit from to approach and benefit from VAD and to the on in the Fontan after the of we often to with management and to As in the of Fontan patients to the of in patients with heart and PubMed and with and for VAD with Fontan and to for the and of and is for to of and can of with require to the is VAD to to for approach is in of is A and approach and clinical of the in the Fontan PubMed the and 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