Abstract | OBJECTIVE: Intractable cyanosis after partial or complete cavopulmonary connection may rarely be managed by creating a systemic arteriovenous fistula. We investigated the long-term performance of arteriovenous fistulae. METHODS: RESULTS: All 21 patients had previously undergone second-stage palliation (Glenn shunt = 13; bidirectional shunt = 9). Five patients had undergone Fontan completion. Death in the presence of a functioning arteriovenous fistula occurred in 5 patients. Patients with bidirectional shunts had a significantly higher risk of death with a functioning arteriovenous fistula in situ (P = .04). High hemoglobin concentrations were associated with best outcome, and levels less than 170 g/L were associated with a high risk of death despite a functioning arteriovenous fistula (P < .01). Arteriovenous fistula occlusion occurred in 10 patients. Earlier occlusion was associated with previous Fontan completion (P = .02) and pulmonary arteriovenous malformations (P = .03). Surgical ligation during cardiac transplantation was the cause of occlusion in 7 patients. In these 7 patients, the arteriovenous fistula functioned for a median of 4.8 years. After transplantation, survival was 67% + or - 19% at 5 years. Overall survival was 73% + or - 10% 15 years after receiving an arteriovenous fistula (longest survival, 27.3 years). CONCLUSION:
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Authors | Edward J Hickey, Abdullah A Alghamdi, Maryam Elmi, Khalid S Al-Najashi, Glen S Van Arsdell, Christopher A Caldarone, John Coles, William G Williams |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 139
Issue 1
Pg. 128-134.e1
(Jan 2010)
ISSN: 1097-685X [Electronic] United States |
PMID | 19922957
(Publication Type: Journal Article)
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Copyright | Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Topics |
- Arteriovenous Malformations
(surgery)
- Arteriovenous Shunt, Surgical
(mortality)
- Cyanosis
(surgery)
- Female
- Fontan Procedure
- Heart Defects, Congenital
(mortality, physiopathology, surgery)
- Heart Transplantation
- Humans
- Infant, Newborn
- Male
- Palliative Care
- Pulmonary Circulation
(physiology)
- Treatment Outcome
- Vena Cava, Superior
(physiology)
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