Letter by Faul et al Regarding Article, “Percutaneous Femoral Arteriovenous Shunt Creation for Advanced Chronic Obstructive Pulmonary Disease: A Single-Center Safety and Efficacy Study”

To the Editor:We were interested to read the recent article by Bertog et al,1 published in your journal. Bertog et al report, for the first time, significant increases in cardiac output, mixed venous oxygen saturations, oxygen delivery, and functional capacity (significant reductions in New York Heart Association [NYHA] functional class) in patients with severe end-stage chronic obstructive pulmonary disease (COPD) with the use of the novel Rox procedure (percutaneous arteriovenous fistula creation).Their interpretation that “the creation of an arteriovenous shunt in the setting of severe chronic obstructive pulmonary disease did not improve functional capacity” is not convincing, because the data prove the opposite: an improved NYHA functional class, which is not only clinically significant (improved from class III to II) but also statistically significant ( P <0.01). Thus, the idea that an arteriovenous shunt (AVS) does not improve functional capacity is refuted by their data that demonstrate statistically significant improvements in NYHA functional class.Although Bertog et al did not demonstrate a significant change in 6-minute walking distance (6MWD) in …