Open Access

ARTICLE

Arteriovenous fistula creation for hypoxia after single ventricle palliation: A single‐institution experience and literature review

Andrew D. Spearman¹, Steven J. Kindel¹, Ronald K. Woods², Salil Ginde^1,3

1 Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
2 Department of Surgery, Division of Pediatric Cardiovascular Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
3 Department of Internal Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin

* Corresponding Author: Andrew D. Spearman, Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226. Email:

Congenital Heart Disease 2019, 14(6), 1199-1206. https://doi.org/10.1111/chd.12828

Abstract

Background: Hypoxia is a common and sometimes severe morbidity of single ven‐ tricle congenital heart disease (CHD). Creation of an arteriovenous fistula (AVF) is occasionally performed for patients after superior or total cavopulmonary connec‐ tion (SCPC or TCPC) in an attempt to improve oxygen saturations. Despite previ‐ ous 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 co‐ hort 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 compli‐ cation (cephalic edema, thrombotic occlusion) was 51.4% at 12 months.
Conclusion: Palliative AVF creation for patients with single ventricle CHD and hy‐ poxia 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 pallia‐ tion for a subset of patients after SCPC who are not candidates for TCPC, or poten‐ tially as a bridge to heart transplantation.

---

Keywords

---