Carotid Artery to Internal Jugular Vein Fistula for the failing cavo-pulmonary shunt

Objective Early hypoxia following superior cavopulmonary anastomosis (SCPA) presents a challenging problem without a simple solution. We recently added carotid artery (CA) to internal jugular (IJ) fistula to our armamentarium of rescue strategies. This series describes the outcomes for those patients. Methods A single center retrospective chart review was performed and included all CA-IJ fistulae performed between 2022-2025. Patients underwent banding of the cephalad IJ along with a CA-IJ anastomosis. Statistics are presented as median (range). Results Four patients underwent CA-IJ fistula. CA-IJ fistulae were performed at a median time of 12 (8-17) days after SCPA. Median age was 198 (119-308) days. PaO2 increased from 39 (21-50) to 43 (31-66). Pre-operative systemic ventricular function was normal in 1, mildly depressed in 2, and moderately depressed in 1 patient. Post-operative systemic ventricular function was normal in 3 and mildly depressed in 1. One patient had successful surgical takedown of their CA-IJ fistula after 202 days. One patient was noted to have spontaneous closure of their fistula after 158 days and has undergone completion Fontan. One patient is being evaluated for fistula takedown after 67 days. One patient failed to have improved oxygenation, requiring ECMO after 5 days and died after 16 days. Conclusions Creation of an CA- IJ fistula can be a successful rescue strategy for failing SCPA patients. The procedure offers a favorable surgical approach, avoiding the need for sternal re-entry and cardiopulmonary bypass in a fragile patient.