Augmenting Venous Return in Fontan Circulation: The Role of the Skeletal Muscle Pump and Implications for Mechanical Compression Devices—A Review of the Literature

Post-Fontan patients often face significant hemodynamic challenges, including systolic dysfunction and diminished cardiac output due to reduced preload and venous return. Long-term complications such as hepatic dysfunction and protein-losing enteropathy arise from poor venous return, increasing morbidity and mortality. Enhancing venous return could potentially improve long-term outcomes for these patients. This literature review examines the role of the skeletal muscle pump in Fontan circulation and evaluates non-pharmacological strategies to augment venous return, with discussion of mechanical compression devices as a potential translational application. A comprehensive literature search identified 26 studies focusing on the relationship between lower limb muscle mass, venous return, and cardiac performance in post-Fontan patients, as well as the efficacy of peristaltic leg pumps in enhancing venous return. Across included studies, higher lower-limb skeletal muscle mass and structured exercise interventions were consistently associated with improved functional and cardiopulmonary performance metrics in Fontan patients. Additionally, the use of peristaltic leg pumps in other patient cohorts enhanced venous return across various patient positions, suggesting an avenue for implementation in the Fontan patient. Peristaltic leg pumps may serve as a valuable tool in managing the hemodynamic challenges of post-Fontan patients, potentially leading to better long-term outcomes. Further research, particularly randomized controlled trials, is necessary to establish the efficacy and optimal application of these devices in the paediatric Fontan population.