Outcomes After Pulmonary Artery Flow Reducer Implantation in High-Risk Neonates With Congenital Heart Disease and Pulmonary Overcirculation.

Abstract

Surgical outcomes in neonates with complex congenital heart disease (CHD) and pulmonary overcirculation (POC) initially palliated with pulmonary flow reducers (PFRs) were evaluated. This was a retrospective study conducted between January 1, 2020 and December 31, 2023. Eleven neonates underwent PFR palliation. Fenestrated Medtronic microvascular plugs (PFRs) were delivered into the branch pulmonary artery (PA). The target surgical procedure involved the removal of PFRs and biventricular repair (n = 9) or single-ventricle palliation (n = 2). Patients were deemed high risk on the basis of prematurity (n = 5), early gestational age (n = 5), heterotaxy (n = 1), hypoxic-ischemic encephalopathy (n = 1), chromosomal abnormality (n = 4), or complex intracardiac anatomy (n = 4). Median age and weight at PFR implantation (PFRI) were 48 days (interquartile range [IQR], 16-85 days) and 2.8 kg (IQR, 1.7-3.4 kg), respectively. Median PFRI time was 84 days (IQR, 33-202 days). Weight gain after PFRI was 20.31 g/d vs 3.75 g/d before PFRI. Complications of PFRI included POC in 2 patients (bilateral PFR migration [n = 1] and embolization [n = 1]), excessive flow restriction (n = 1), PFR release failure (n = 1), and malposition (n = 1). All patients were bridged to the target surgical procedure. Devices were surgically removed without the need for PA reconstruction. There was 1 in-hospital mortality after targeted surgery, and 9 of 11 patients achieved 1-year survival. One-year echocardiographic follow-up showed 3 of 22 PAs with mild stenosis. Outcomes in high-risk neonates with complex CHD and POC are good after PFR palliation. Removal of PFRs is feasible without PA stenosis.