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Off-pump hepatic to azygos connection via thoracotomy for relief of fistulas after a Kawashima procedure: Ten-year results

Arrigoni, S. C., van den Heuvel, F., Willems, T. P., Hillege, H., Lindberg, H. L., Berger, R. M. F. & Ebels, T., Jun-2015, In : JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. 149, 6, p. 1524-1530 7 p.

Research output: Contribution to journalArticleAcademicpeer-review

Objectives: An almost universal incidence of developing pulmonary arteriovenous fistulas after the Kawashima operation has been reported. Exclusion of the hepatic venous flow from the pulmonary circulation causes the development of these malformations. Redirection of hepatic venous flow to the pulmonary circulation mostly leads to the regression of the arteriovenous fistulas.

Methods: We analyzed 11 patients with arteriovenous fistulas that developed after the Kawashima operation. The hepatic-to-azygos shunts were performed with an off-pump technique through a lateral thoracotomy in all but one. Operative and postoperative data were retrospectively collected.

Results: No intraoperative complications occurred, and no patient died in the hospital. Up to 10-year follow-up showed a significant postoperative improvement of patients' oxygen saturation and New York Heart Association class. Apart from 2 re-thoracotomies for bleeding in 1 patient, no complications occurred and no patient died during follow-up. Two other patients underwent reoperation for an undiagnosed additional hepatic vein. The improvement of patients' oxygen saturation and New York Heart Association class persisted during the follow-up period.

Conclusions: The surgical connection can be performed safely with an off-pump technique that avoids the risks related to extracorporeal circulation and circulatory arrest. The results at 10 years follow-up confirmed the efficacy and safety of the surgical technique described.

Original languageEnglish
Pages (from-to)1524-1530
Number of pages7
JournalJOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume149
Issue number6
Publication statusPublished - Jun-2015

    Keywords

  • Fontan procedure, congenital heart defect, collateral circulation, thoracotomy, PULMONARY ARTERIOVENOUS-MALFORMATIONS, TOTAL CAVOPULMONARY CONNECTION, HEART-DISEASE, OPERATION, CIRCULATION, HETEROTAXY, OUTCOMES, SURGERY, SHUNT, VEIN

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