Fontan assist devices; A systematic review of twenty years of experimental and in vivo trials

Abstract

Background

The Fontan completion represents the final phase of univentricular repair, which drains the inferior vena cava against gravity into a higher-pressure pulmonary arterial circulation. The passive and anti-gravity characteristics of this circulation make encountering a failing Fontan not uncommon. Twenty years ago, experiments exploring the potential of vascular pumps to bolster the passive Fontan have started, and trials are still ongoing.

Aim of review

Through this review, our aim is to summarize the outcomes of these trials.

Key scientific concepts and findings of review

A total of ten trials have been included, encompassing 23 different settings. Three distinct designs were identified, of which two are classified as pump designs: the connecting chamber and the intravascular pump designs. Only one trial investigated the potential use of a compression device. The most frequently encountered design in vivo was the intravascular pump, accounting for 67 % of the cases. There were no reports of significant hemolysis or thrombosis. However, an increasing flow rate exceeding 5 L/min was associated with negative outcomes in the connecting chamber design due to rising upstream pressure in the SVC. In contrast, intravascular pumps did not exhibit this limitation.