title: Axillary arteriovenous fistula for the palliation of complex cyanotic congenital heart disease: is it an effective tool?
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.
authors.affiliation: University of Alberta Stollery Children's Hospital, Edmonton, Alberta, Canada. quinonez.luis@gmail.com
authors.forename: Luis G
authors.initials: LG
authors.lastname: Quiñonez
authors.forename: Morgan L
authors.initials: ML
authors.lastname: Brown
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Puga
mesh_terms: D000293:Adolescent; D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001366:Axillary Artery / Q000601:surgery*; D001367:Axillary Vein / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D008910:Minnesota; D010100:Oxygen / Q000097:blood; D010166:Palliative Care; D011086:Polycythemia / Q000209:etiology / Q000601:surgery; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D010100:Oxygen