The Fontan physiology is essentially a form of chronic right heart failure associated with elevated central venous pressures (CVP). Due to improvements in operative procedures, timing, staging, and management, operative mortality is now less than 5% and survival at 20 yr is 84% [1]. However, morbidity is significant due to venous congestion and elevated pulmonary vascular resistance (PVR), progressive ventricular dysfunction, dysrhythmias, hypoxemia, and protein-losing enteropathy. Heart transplantation in failed Fontan patients yields survival similar to non-Fontan patients. However, many Fontan patients are not considered for transplantation due to multi-organ failure, high PVR, prior surgeries, and sensitization. A conservative estimate of the number of patients who would benefit from mechanical support may be based on the number of failed Fontan circulations. For example, in a total of 247 Fontan patients who were followed, there were 42 (16.3%) late failures (25 deaths, 2 Fontan takedowns, 9 heart transplantations, and...

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