Inside Pediatrics Spring 2025

Law and his team have presented a series of five cases in which they used the technique on babies who were too medically fragile for surgery. All survived and all were later able to undergo the needed open surgery. “We’re confident some of these babies wouldn’t have made it otherwise,” he said. “But because they’re older, bigger, stronger and breathing on their own” the procedure was much less risky.

Now, Law and his team are able to treat the infant in the cath lab rather than an operating room. There, they thread the plug through the femoral or internal jugular vein into the pulmonary artery to partially restrict excessive blood flow to the lungs. “It’s a far less invasive procedure and the recovery is faster,” he said. It also allows the surgeons to operate without scar tissue from a previous surgical procedure.

This procedure enables babies who are too fragile for surgery to safely grow stronger before undergoing their first operation. In one study, 10 out of 13 infants treated with this technique survived to their next surgery, typically performed within two to six months of the catheter procedure. When compared to historical data from similar high-risk patients who underwent traditional procedures, the new technique was associated with significantly better six-month survival rates after adjusting for other risk factors. Importantly, the baby’s pulmonary arteries grow over that time, which is crucial for their long-term outcomes. In addition, the devices can be easily removed during subsequent surgical procedures. Law and his team have presented a series of five cases in which they used the technique on babies who were too medically fragile for surgery. All survived, and all were later able to undergo the needed open surgery. “We’re confident some of these babies wouldn’t have made it otherwise,” he said. “But because they’re older, bigger, stronger and breathing on their own” the procedure was much less risky. Still, challenges remain. The device must be customized for each patient, and its small size limits its use to very young infants. Nonetheless, pediatric cardiologists across the country are adopting the procedure, Law said. “We’re all learning from each other and sharing data to refine the technique.” “This technique represents a shift in how we think about treating congenital heart defects,” said Law. “The ability to delay surgery and avoid scar tissue is a game changer.” ●

With the use of this tiny device—inserted non- invasively—doctors are able to postpone a patient’s surgery until their body is ready for it.

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