The increasing utilization of ventricular assist devices in fontan failure.

The Fontan population has increased dramatically owing to advances in medical and surgical therapies, with many living well into adulthood with Fontan circulation. Unfortunately, patients will develop heart failure due to the chronic effects of their altered circulatory system. Management of heart failure in these patients is very complex and requires multi-disciplinary approaches with input from both cardiologists and surgeons. In the case of patients who develop cardiogenic shock, transplantation is often not feasible due to instability. Recently, there has been increased use of ventricular assist devices (VADs) as a bridge to transplantation with promising results. In this work, we briefly review the physiology of Fontan failure, provide criteria for VAD workup, and discuss VAD outcomes in Fontan patients. Finally, we describe a single institution's experience and outcomes with VADs in Fontan patients.