Objectives: We report our experience with telemetrically adjustable PAB FloWatch® and assess its limitations.
Methods: Eleven infants, mean age 2.4 months (10 days to 10 months), mean weight 3.8kg (2.3 to 7.0kg) underwent implantation of FloWatch® through median sternotomy from May 2006 to June 2008. Diagnosis was complex/multiple ventricular septal defects (VSDs) (8), atrio-ventricular septal defect (2), congenitally Corrected TGA (1).
Results: Neither death nor device-related complication occurred during a mean follow-up of 15.4 months (1 day to 30 months). A mean of 3.1 adjustments/patient were required, in 85% of cases (29/34) to narrow the pulmonary artery and in 15% (5/34) to release it. Four infants had removal of device (one at repair for atrio-ventricular septal defect, two for VSD closure, eight, six and eight months later respectively, and one for chest encumbrance the same day of implantation in a patient weighing 2.8 Kg).
Conclusion: In this initial series we experienced a single haemodynamic compromise due to the bulk of the device in the small chest of a patient. In another series, one of the authors (MP) met two other cases requiring immediate removal of FloWatch®: one for coronary and one for left superior vena cava compression. Despite that, this technology may obviate the need for re-operations and shorten the stay in ICU, and appears a suitable surgical option for left ventricular re-training. However it is not suitable for all anatomic conditions and, given the cost of the device, it could be advisable use a test device prior to implantation.