Selection Criteria for Axillary Arteriovenous Fistula in Patients with Functionally Single Ventricle after Cavopulmonary Shunt

Dmitry Kovalev, Vladimir Podzolkov, Ivan Yurlov, Michail Zelenikin, Victor Samsonov , Nickolay Chikin, Manoulis Pursanov, Ludmila Yurpol’skaya, Tatayna Mataeva

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objectives:The presence of contraindications to Fontan operation and progressive deterioration of the condition, including a decrease of the arterial blood oxygen saturation (SataO2), in some patients with univentricular hemodynamics at the mid-term or late follow up after cavopulmonary connection (CPC) require alternative approaches in surgical treatment.

The Goalof the study is to determine the selection criteria for patients with a functionally single ventricle after a cavopulmonary anastomosis for an axillary arterio-venous fistula (AAVF).

Methods:From2012 to 2017, 21 patientsaged21 ± 8.7 years inour institution underwent AAVF after bidirectional CPC (BCPC) in 19, Fontan procedure in 1 and take down Fontan in1/.The interval betweenBCPCandAAVFwas 13.9 ± 7.2 years. The clinical and hemodynamic parameters of the patients were assessed pre- and post-surgery.

Results:There was no hospital mortality and 2 late deaths due tosevere concomitant pathology. Survival at 5 years follow up was 90%. The increase of SatO2 in the mid-term was up to 81.7 ± 5.4% at mean (p <0.01) and the SVC blood flow velocity exceeded 26.5 ± 1.1 cm / s (p <0.022). EF of a single ventricle and hemoglobin level did not change significantly. , Seventeen patients were classified as NYHA functional capacity (FC) 3and three as FC 4; post-surgery nine patients were FC 2and three FC3. One patient underwent a Fontan operation within 3 years.

Conclusions:Adult age and a long interval after BCPC, severe arterial hypoxemia, take down Fontan,high risk of Fontan completion due to: hypoplasia of the pulmonary arteries, severe concomitant pathology can be considered as selection criteria for patients with a functionally single ventricle of the heart after a CPC.