Abstract
Objective. The goal of the study is to reveal indications and present results of axillary arteriovenous fistula (AAVF) in patients with functionally single ventricle after cavopulmonary connection of a high risk for the Fontan operation.
Material and methods. During 2012 to 2017, in 20 patients after bidirectional cavopulmonary connection (BCPC). The age was 21±8.7 years. The interval between BCPA and AAVF was 13.9±7.2 years. The SataO2 before surgery was 72.4±7.1%, Hb 185±35.6 g/l, pulmonary arterial index 270±159.2 mm2/m2, the McGoon index 1.69±0.52, the ejection fraction (EF) of single ventricle was 58±6.8%. In 9 cases, an additional source of pulmonary blood flow was preserved.
Results. There was no hospital mortality. Paresthesia of the arm persisted for 1–7 days. SataO2 increased to 82±5.5% (p<0.01). EF 58.6±4.9%. The speed and minute volume of blood flow in SVC increased from 21.1 to 28.8 cm/s and from 10.6 to 12.5 ml/s, respectively. At the mid-term period (1–5 years), 2 patients died from concomitant pathology. SataO2 in 12 patients was 84±6.5% (p<0.01). The Hb, Hct, and EF values did not change significantly and remained on the same level. Stable improvement in the state and tolerance to physical activity was noted: 9 patients were in II functional class (FC) and 3 in III FC NYHA. One patient underwent Fontan operation in 3 years.
Conclusion. Axillary arteriovenous fistula is an effective method of increasing pulmonary blood flow in patients with univentricular hemodynamics and previously performed CPA in the following cases: when Fontan operation can not be performed, patients with severe arterial hypoxemia, at the presence of pulmonary arteriovenous fistulas, with low EF. The AAVF can be of the stage of surgical treatment and a bridge to Fontan operation and/or heart transplantation for this category of patients.
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About the authors
- Podzolkov Vladimir Petrovich, Dr. Med. Sc., Professor, Academician of RAS, Head of Department; orcid.org/0000-0002-4636-8463
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Kovalev Dmitriy Viktorovich, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-4586-9258
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Yurlov Ivan Aleksandrovich, Cand. Med. Sc., Surgeon; orcid.org/0000-0002-5812-8408
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Zelenikin Mikhail Mikhaylovich, Dr. Med. Sc., Professor, Head of Department; orcid.org/0000-0002-1298-2940
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Samsonov Viktor Borisovich, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-6477-7914
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Chikin Nikolay Semenovich, Junior Researcher; orcid.org/0000-0003-2173-6722
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Yurpol'skaya Lyudmila Anatol'evna, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0001-7780-2405
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Mataeva Tat'yana Valer'evna, Cand. Med. Sc., Radiation Diagnostics Physician; orcid.org/0000-0001-7595-6080
