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Ventricular assist devices are increasingly being used for patients with single ventricle physiology. We describe the use of single ventricular assist device (SVAD) therapy in individuals with Fontan circulatory failure. Retrospective, single center review of all patients with Fontan circulation implanted with an SVAD between 2016 and 2021. Patient characteristics and clinical outcomes were obtained by chart review. Seven patients underwent SVAD implantation between 2016 and 2021 (Table 1). Median age at implant was 25.3 (IQR 22.1-37.8) years; most had a lateral tunnel Fontan (71%), a systemic left ventricle (57%), and were implanted as a bridge to transplant candidacy. Concomitant surgical intervention at the time of SVAD implantation was common (Table 2). SVAD support continued for a median of 65 (IQR 39-283) days (d); 1 patient was successfully supported for 1105 d. Five patients had a positive outcome: 4 transplanted, 1 alive on device. One patient underwent combined heart-liver transplant. Of the 4 discharged home the median length of stay was 29 d and the median calculated VAD flow at discharge was 3.8 L/min/m2. All 4 transplanted patients remain alive (median time since-transplant 713 d). The 2 deaths were due to multisystem organ failure. SVAD support is a viable option for teenagers and young adults with Fontan circulatory failure despite the surgical complexity and challenging SVAD management (high calculated VAD flow). This suggests a role for advanced surgical modeling to optimize device positioning and highlights the need for continued multicenter collaboration to advance complex SVAD management strategies. [ABSTRACT FROM AUTHOR]