title: Outcome following augmentation of superior cavopulmonary blood flow with an arteriovenous fistula.
abstract: BACKGROUND
  Axillary or brachial arteriovenous fistulae are occasionally created to improve systemic oxygen saturation in patients with functionally univentricular circulation after superior cavopulmonary anastomosis. Different techniques of fistula construction may account for the conflicting results. We sought to determine the impact of axillary arteriovenous fistula on systemic oxygen saturation and survival before subsequent palliation or heart transplantation.
  
  
  METHODS
  Medical records of patients who underwent a side-to-side anastomosis between an adjacent axillary artery and vein for cyanosis after superior cavopulmonary anastomosis between 1991 and 2010 were reviewed.
  
  
  RESULTS
  The median age (n = 23) at the time of fistula creation was 54 months (4-278 months). There was no operative mortality. The median duration of fistula patency was 48 months (1-174 months). Oxygen saturation improved from 71% ± 10% preoperatively to 84% ± 4% early (P < .05) and 81% ± 4% long term after the arteriovenous fistula (P < .05). Twelve patients underwent additional surgery (total cavopulmonary anastomosis 6, partial biventricular repair 2, and heart transplantation 4) after an interval of 10 to 141 months. Six patients are alive with a patent fistula without subsequent interventions after an interval of 48 to 174 months. Two patients with spontaneous closure or device closure of the fistula are alive after an interval of 76 to 80 months without subsequent interventions. Three deaths occurred with a patent fistula without subsequent interventions after an interval of 1 to 84 months.
  
  
  CONCLUSIONS
  Systemic oxygen saturation improved with creation of an axillary arteriovenous fistula after superior cavopulmonary anastomosis. The fistula extended the duration of this stage of palliation without precluding the option for additional palliation or heart transplantation.
authors: Department of Pediatrics, Division of Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA nitin.chanana@hsc.utah.edu.
authors: Nitin
authors: N
authors: Chanana
authors: Department of Pediatrics, Division of Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
authors: Ronald W
authors: RW
authors: Day
authors: Department of Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
authors: Edwin C
authors: EC
authors: McGough
authors: Department of Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
authors: Phillip T
authors: PT
authors: Burch
mesh_terms: D000293:Adolescent; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001366:Axillary Artery / Q000601:surgery; D001367:Axillary Vein / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000097:blood / Q000601:surgery; D005260:Female; D018610:Heart Bypass, Right / Q000379:methods; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010166:Palliative Care / Q000379:methods; D011652:Pulmonary Circulation / Q000502:physiology; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
chemical_list: D010100:Oxygen
keywords: CHD; Fontan; cavopulmonary anastomosis; fistula; univentricular heart