Faculty Collaboration Database

Arteriovenous fistula creation for hypoxia after single ventricle palliation: A single-institution experience and literature review. Congenit Heart Dis 2019 Nov;14(6):1199-1206

Date

08/02/2019

Pubmed ID

31368206

DOI

10.1111/chd.12828

Scopus ID

2-s2.0-85070107730 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: Hypoxia is a common and sometimes severe morbidity of single ventricle congenital heart disease (CHD). Creation of an arteriovenous fistula (AVF) is occasionally performed for patients after superior or total cavopulmonary connection (SCPC or TCPC) in an attempt to improve oxygen saturations. Despite previous reports, AVF creation is a rare palliation with inadequately defined benefits and risks. We sought to determine changes in peripheral oxygen saturation (SpO₂ ) and risk of adverse event after AVF creation in children with single ventricle CHD at our institution.

METHODS: We conducted a retrospective chart review of patients with a history of single ventricle palliation and history of surgical AVF creation who were seen at our tertiary care center from 1996 to 2017.

RESULTS: A total of seven patients were included in our study. SpO₂ for the overall cohort did not significantly increase after AVF creation (pre-AVF 79.1 ± 6.9%, post-AVF 82.7 ± 6.0% [P = .23]). SpO₂ trended up for large shunts (>5 mm) (pre-AVF 75.0 ± 7.6%, post-AVF 84.0 ± 5.3% [P = .25]). SpO₂ did not improve for small shunts (≤5 mm) (pre-AVF 82.3 ± 6.5%, post-AVF 81.0 ± 8.5% [P = .50]). The 12-month overall and transplant-free survival were 85.7% and 71.4%, respectively. Freedom from AVF-related complication (cephalic edema, thrombotic occlusion) was 51.4% at 12 months.

CONCLUSION: Palliative AVF creation for patients with single ventricle CHD and hypoxia does not universally improve SpO₂ and is prone to early complications. Despite a lack of durable benefit and known risks, AVF creation remains a reasonable palliation for a subset of patients after SCPC who are not candidates for TCPC, or potentially as a bridge to heart transplantation.

Author List

Spearman AD, Kindel SJ, Woods RK, Ginde S

Authors

Salil Ginde MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
Steven J. Kindel MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Andrew Spearman MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Arteriovenous Shunt, Surgical
Child
Child, Preschool
Female
Fontan Procedure
Heart Bypass, Right
Heart Defects, Congenital
Heart Transplantation
Heart Ventricles
Humans
Hypoxia
Male
Oxygen
Palliative Care
Retrospective Studies
Risk Factors
Time Factors
Young Adult