First-Ever HeartMate 3 VAD Implant in a Patient with a Fontan Circulation
A team from the Heart Institute recently implanted a ventricular assist device (VAD) in a patient with a failing Fontan circulation. Brandon Collinsworth, 23, was the first patient in the United States with only one heart chamber to receive the newest VAD technology, the HeartMate 3 made by Abbott.
Brandon was diagnosed with hypoplastic left heart in utero when his mother was five months pregnant. After he was born, he underwent a series of operations to create a Fontan circulation so he could live with a single ventricle. But at age 23, Brandon’s ventricle began to give out. His Fontan circulation, created to flow blood through the lungs without being pumped by the heart, was failing.
Two Sites, One Program
A collaboration between UK HealthCare and Cincinnati Children’s led to Brandon’s VAD implant. These two organizations formed the Joint Pediatric Heart Program, where they operate in two sites but as one program. The care teams work together to provide advanced care for patients in Kentucky with congenital and acquired pediatric heart disease, including adults with congenital heart disease.
Brandon, of Paintsville, Kentucky, was having a procedure done at UK HealthCare when his heart stopped. The team there quickly stabilized him with a lifesaving procedure. Because of the Joint Pediatric Heart Program, Brandon’s care providers in Kentucky were in direct contact with the team in Cincinnati and got him to Cincinnati Children’s for further care without delay.
After evaluation, Brandon was listed for heart transplantation, but while waiting, he became weaker and more unstable. His care team determined that implanting a ventricular assist device would give Brandon the best chance of surviving until transplant.
An Ideal Device for Those with a Fontan Circulation
The HeartMate 3 recently became approved for use in adults. “We chose this device because it is the first completely magnetically suspended VAD, which we believe will allow for patients to live with the device for long periods of time—potentially even years—with lower complication rates,” says Angela Lorts, MD, medical director of ventricular assist devices with the Heart Institute.
The HeartMate 3 uses the magnetically suspended rotor to power blood out of the heart and into the aorta, taking over the pumping function of the heart. The team also believes the HeartMate 3 may be an ideal device for the failing Fontan population because of its unique flow and decompressing characteristics.
“Although heart transplant is wonderful, it can’t always be the answer for these patients, both because of the lack of available organs and because sometimes these patients are so sick that they do not do well with a transplant. The VAD can make them a better transplant candidate,” says David L.S. Morales, MD, director of Congenital Heart Surgery with the Heart Institute.
In addition to being the first patient with a Fontan to receive a VAD, Brandon also is the first patient in a pediatric hospital to be implanted with a HeartMate 3.
An Option for Others with Failing Fontans
“There are approximately 17,000 patients with Fontan circulation in the U.S.,” Lorts says. “We are finding that this circulation is not always adequate to enable patients to live into late adulthood. We continue to look for devices that will support these patients, and the HeartMate 3 appears to be a good option. We suspect that the Fontan population will be our largest population requiring support in the near future. We are happy with Brandon’s outcome, and we hope to help others with failing Fontan circulation in the future.”
Since receiving the implant, Brandon’s health has improved significantly. He remains on the heart transplant list but is enjoying life at home and continues to get stronger every day.
“I am excited that Brandon’s case has helped pave the way for taking care of this quickly growing population of Fontan patients with heart failure,” Morales says. “In addition, it highlights a truly seamless continuum of care between UK Health and the Cincinnati Children’s Adult Congenital Heart Disease and VAD Programs, which is all made possible by our Joint Heart Program.”
