Anesthetic Implications and Physiologic Response to Transcatheter Pulmonary Flow Restrictor Placement in Neonates: A Single-Center Cohort Study.

OBJECTIVE

To characterize intraprocedural anesthetic management and physiologic responses during sequential transcatheter pulmonary flow restrictor (PFR) implantation in neonates and infants with complex congenital heart disease.

DESIGN

Single-center retrospective cohort study.

SETTING

Tertiary congenital cardiac catheterization laboratory at an academic children's hospital.

PARTICIPANTS

Twenty-two neonates and infants undergoing sequential bilateral PFR implantation.

INTERVENTIONS: Transcatheter deployment of modified microvascular plug pulmonary flow restrictors under general anesthesia with either volatile or intravenous anesthetic techniques.

MEASUREMENTS AND MAIN

RESULTS

Ventilatory (oxygen saturation [SpO2], FiO2, EtCO2, peak inspiratory pressure, tidal volume) and hemodynamic variables (mean arterial pressure, systolic blood pressure, diastolic blood pressure, heart rate) were collected at 3 standardized timepoints: predeployment, after PFR 1 deployment, and after PFR 2 deployment. Statistical analysis used the Friedman test and post-hoc pairwise Wilcoxon signed-rank comparison with Benjamini-Hochberg FDR adjustment. PFR placement reduced SpO₂ from 93% to 88% (Friedman Q = 7.878, p = 0.019) while producing significant stepwise increases in systemic pressures (mean arterial pressure increased from 42.5 to 54.5 mmHg, Friedman Q = 21.04, p = 2.7 × 10⁻⁵) and reductions in heart rate (152 to 144 bpm, Friedman Q = 9.33, p = 0.0094). Volatile anesthesia was initially used in 1,7/22 patients, although 4 required conversion to intravenous anesthesia due to hemodynamic compromise. Despite these anesthetic transitions, ventilatory parameters, including EtCO₂, PIP, and tidal volume, remained stable, with only modest increases in FiO₂ requirements.

CONCLUSION

PFR deployment results in stable ventilatory physiology and predictable saturation and hemodynamic responses. These findings provide practical anesthetic guidance and characterize the intra-procedural physiology of this emerging palliation strategy.