@Article{chd.12828,
AUTHOR = {Andrew D. Spearman, Steven J. Kindel, Ronald K. Woods, Salil Ginde},
TITLE = {Arteriovenous fistula creation for hypoxia after single ventricle palliation: A single‐institution experience and literature review},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {1199--1206},
URL = {http://www.techscience.com/schd/v14n6/38899},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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 (SpO<sub>2</sub>) and
risk of adverse event after AVF creation in children with single ventricle CHD at our
institution.<br/>
<b>Methods:</b> 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.<br/>
<b>Results:</b> A total of seven patients were included in our study. SpO<sub>2</sub> 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]). SpO<sub>2</sub> trended up for large shunts (>5 mm) (pre‐AVF 75.0 ± 7.6%,
post‐AVF 84.0 ± 5.3% [P = .25]). SpO<sub>2</sub> 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.<br/>
<b>Conclusion:</b> Palliative AVF creation for patients with single ventricle CHD and hy‐
poxia does not universally improve SpO<sub>2</sub> 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.},
DOI = {10.1111/chd.12828}
}