Axillary arteriovenous fistula for the palliation of complex cyanotic congenital heart disease: Is it an effective tool?

Luis G. Quiñonez, Morgan L. Brown, Joseph A. Dearani, Harold M. Burkhart, Francisco J. Puga

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: Patients with complex cyanotic congenital heart disease and a bidirectional cavopulmonary connection who are not candidates for or had failed Fontan operation may experience progressive cyanosis. An axillary arteriovenous anastomosis may be constructed to augment pulmonary blood flow. This report reviews our results with this approach in this complex group of patients. Methods: The records of patients with previous cavopulmonary connections who underwent a surgical anastomosis between the axillary artery and the vein for palliation of severe progressive cyanosis were reviewed. Results: Eleven patients were identified. The median age at the time of the axillary arteriovenous anastomosis was 19.2 years (7.97-41.75 years). Seven patients were not candidates for the Fontan operation, and 4 patients had failed Fontan surgery. Three of the anastomoses were constructed with a side-to-side technique, and 8 anastomoses were constructed with a short interposition graft. Median fistula size was 5 mm (3-6 mm). There was no operative mortality and 1 late death. Median survival was 2.85 years (0.01-7.22 years). All fistulae were patent at follow-up. Median preoperative arterial oxygen saturation was 84% (80%-86%) and 82% (76%-88%) at follow-up (P = .38). Median preoperative hemoglobin was 18.5 g/dL (11.7-22.6 g/dL) and 19.2 g/dL (14.6-22.6 g/dL) at follow-up (P = .97). Median preoperative systemic ventricular ejection fraction was 51% (27%-60%) and 46.5% (28%-60%) at follow-up (P = 1). Significant functional improvement was seen in only 1 patient. Conclusions: In patients with complex cyanotic congenital heart disease who are not candidates for or had failed Fontan operation, palliation with an axillary arteriovenous fistula did not improve cyanosis or polycythemia. Functional outcome and ventricular ejection fraction did not improve or deteriorate.

Original languageEnglish (US)
Pages (from-to)188-192
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume141
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Arteriovenous Fistula
Heart Diseases
Fontan Procedure
Cyanosis
Arteriovenous Anastomosis
Stroke Volume
Fistula
Surgical Anastomosis
Axillary Vein
Axillary Artery
Polycythemia
Hemoglobins
Oxygen
Transplants
Lung
Survival
Mortality

Keywords

  • AAV
  • arterial oxygen saturation
  • axillary arteriovenous
  • EF
  • ejection fraction
  • Hb
  • hemoglobin
  • polytetrafluoroethylene
  • PTFE
  • Sao

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Axillary arteriovenous fistula for the palliation of complex cyanotic congenital heart disease : Is it an effective tool? / Quiñonez, Luis G.; Brown, Morgan L.; Dearani, Joseph A.; Burkhart, Harold M.; Puga, Francisco J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 141, No. 1, 01.2011, p. 188-192.

Research output: Contribution to journalArticle

Quiñonez, Luis G. ; Brown, Morgan L. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Puga, Francisco J. / Axillary arteriovenous fistula for the palliation of complex cyanotic congenital heart disease : Is it an effective tool?. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 141, No. 1. pp. 188-192.
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abstract = "Objective: Patients with complex cyanotic congenital heart disease and a bidirectional cavopulmonary connection who are not candidates for or had failed Fontan operation may experience progressive cyanosis. An axillary arteriovenous anastomosis may be constructed to augment pulmonary blood flow. This report reviews our results with this approach in this complex group of patients. Methods: The records of patients with previous cavopulmonary connections who underwent a surgical anastomosis between the axillary artery and the vein for palliation of severe progressive cyanosis were reviewed. Results: Eleven patients were identified. The median age at the time of the axillary arteriovenous anastomosis was 19.2 years (7.97-41.75 years). Seven patients were not candidates for the Fontan operation, and 4 patients had failed Fontan surgery. Three of the anastomoses were constructed with a side-to-side technique, and 8 anastomoses were constructed with a short interposition graft. Median fistula size was 5 mm (3-6 mm). There was no operative mortality and 1 late death. Median survival was 2.85 years (0.01-7.22 years). All fistulae were patent at follow-up. Median preoperative arterial oxygen saturation was 84{\%} (80{\%}-86{\%}) and 82{\%} (76{\%}-88{\%}) at follow-up (P = .38). Median preoperative hemoglobin was 18.5 g/dL (11.7-22.6 g/dL) and 19.2 g/dL (14.6-22.6 g/dL) at follow-up (P = .97). Median preoperative systemic ventricular ejection fraction was 51{\%} (27{\%}-60{\%}) and 46.5{\%} (28{\%}-60{\%}) at follow-up (P = 1). Significant functional improvement was seen in only 1 patient. Conclusions: In patients with complex cyanotic congenital heart disease who are not candidates for or had failed Fontan operation, palliation with an axillary arteriovenous fistula did not improve cyanosis or polycythemia. Functional outcome and ventricular ejection fraction did not improve or deteriorate.",
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N2 - Objective: Patients with complex cyanotic congenital heart disease and a bidirectional cavopulmonary connection who are not candidates for or had failed Fontan operation may experience progressive cyanosis. An axillary arteriovenous anastomosis may be constructed to augment pulmonary blood flow. This report reviews our results with this approach in this complex group of patients. Methods: The records of patients with previous cavopulmonary connections who underwent a surgical anastomosis between the axillary artery and the vein for palliation of severe progressive cyanosis were reviewed. Results: Eleven patients were identified. The median age at the time of the axillary arteriovenous anastomosis was 19.2 years (7.97-41.75 years). Seven patients were not candidates for the Fontan operation, and 4 patients had failed Fontan surgery. Three of the anastomoses were constructed with a side-to-side technique, and 8 anastomoses were constructed with a short interposition graft. Median fistula size was 5 mm (3-6 mm). There was no operative mortality and 1 late death. Median survival was 2.85 years (0.01-7.22 years). All fistulae were patent at follow-up. Median preoperative arterial oxygen saturation was 84% (80%-86%) and 82% (76%-88%) at follow-up (P = .38). Median preoperative hemoglobin was 18.5 g/dL (11.7-22.6 g/dL) and 19.2 g/dL (14.6-22.6 g/dL) at follow-up (P = .97). Median preoperative systemic ventricular ejection fraction was 51% (27%-60%) and 46.5% (28%-60%) at follow-up (P = 1). Significant functional improvement was seen in only 1 patient. Conclusions: In patients with complex cyanotic congenital heart disease who are not candidates for or had failed Fontan operation, palliation with an axillary arteriovenous fistula did not improve cyanosis or polycythemia. Functional outcome and ventricular ejection fraction did not improve or deteriorate.

AB - Objective: Patients with complex cyanotic congenital heart disease and a bidirectional cavopulmonary connection who are not candidates for or had failed Fontan operation may experience progressive cyanosis. An axillary arteriovenous anastomosis may be constructed to augment pulmonary blood flow. This report reviews our results with this approach in this complex group of patients. Methods: The records of patients with previous cavopulmonary connections who underwent a surgical anastomosis between the axillary artery and the vein for palliation of severe progressive cyanosis were reviewed. Results: Eleven patients were identified. The median age at the time of the axillary arteriovenous anastomosis was 19.2 years (7.97-41.75 years). Seven patients were not candidates for the Fontan operation, and 4 patients had failed Fontan surgery. Three of the anastomoses were constructed with a side-to-side technique, and 8 anastomoses were constructed with a short interposition graft. Median fistula size was 5 mm (3-6 mm). There was no operative mortality and 1 late death. Median survival was 2.85 years (0.01-7.22 years). All fistulae were patent at follow-up. Median preoperative arterial oxygen saturation was 84% (80%-86%) and 82% (76%-88%) at follow-up (P = .38). Median preoperative hemoglobin was 18.5 g/dL (11.7-22.6 g/dL) and 19.2 g/dL (14.6-22.6 g/dL) at follow-up (P = .97). Median preoperative systemic ventricular ejection fraction was 51% (27%-60%) and 46.5% (28%-60%) at follow-up (P = 1). Significant functional improvement was seen in only 1 patient. Conclusions: In patients with complex cyanotic congenital heart disease who are not candidates for or had failed Fontan operation, palliation with an axillary arteriovenous fistula did not improve cyanosis or polycythemia. Functional outcome and ventricular ejection fraction did not improve or deteriorate.

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