Purpose of reviewSince the advent of the Fontan palliation, survival of patients with univentricular congenital heart disease has increased significantly. These patients will, however, ultimately develop heart failure requiring advanced therapies such as heart transplantation. As wait times are long, mechanical circulatory support (MCS) is an attractive therapy, both for bridge to transplantation and destination therapy in patients not suitable for transplantation. This review aims to summarize current thinking about how to determine which patients would benefit from a ventricular assist device (VAD), the optimal time for implantation and which device should be considered.
Recent findingsVAD implantation in end-stage Fontan is still in its infancy; however, case reports and research interest have increased extensively in the past few years. Mortality is significantly higher than in noncongenital heart disease patients. Implantation in patients with primarily systolic dysfunction is indicated, whereas patients with increased transpulmonary gradient may not benefit from a single-VAD solution. When possible, implantation should occur prior to clinical decompensation with evidence of end-organ damage, as outcomes at this point are worse.
SummaryFontan patients demonstrating signs of heart failure should be evaluated early and often for feasibility and optimal timing of VAD implantation. The frequency of this procedure will likely increase significantly in the future.
In a prospective longitudinal study of patients in a general surgical ward, the relative cost‐efficiencies of a long‐acting third generation cephalosporin (ceftriaxone—mean plasma elimination t1/2 390 min) and a short‐acting second generation cephalosporin (cephamandole: mean plasma elimination t1/2 32 min) were determined. The total cost of therapy for 24 h was $32.88 for cephamandole and $22.78 for ceftriaxone, that is, a reduction of 31%. Considerable cost containment can be achieved by using third generation cephalosporin agents that only require the administration of one intravenous injection per day.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.