P1.068: Long-Term Outcomes of Anti-Reflux Procedures in Infants with Congenital Heart Disease

Background: Infants with structural congenital heart disease (CHD), particularly those with single-ventricle physiology, are at a high risk of life-threatening complications secondary to gastroesophageal reflux and aspiration. Nissen fundoplication with gastrostomy tube (GT) placement can reduce reflux/aspiration, improve feeding tolerance, and support growth in these infants, which improves success for cardiac repairs. Previous studies have examined anesthesia risks and short-term risks of anti-reflux procedures in these patients, however long-term outcomes are unclear, especially surgical complications and durability of fundoplication.

Methods: After IRB approval, a single-institution retrospective chart review was performed. Patients were identified using CPT codes for anti-reflux procedures between 2012 and 2024 and then screened to include only those with documented CHD pathologies. Patient demographics, medical/surgical history, and short- and long-term outcomes after hospital discharge were examined. The cohort was described with counts and percentages for categorical variables, median and interquartile ranges for continuous variables.

Results: Sixty-seven patients were included (Table 1) with a median duration of follow up of 2.0 years [3.7 - 5.3]. Thirty-one (46.3%) patients had single-ventricle cardiac physiology while 36 (53.7%) had biventricular physiology, and all patients had at least one additional comorbidity. Median age at time of Nissen was 5 months [3-8] and was typically performed either between staged cardiac repair procedures (35.8%) or after cardiac repair (40.3%) (Table 1). The majority of patients underwent laparoscopic Nissen fundoplication (95%), with 2 patients requiring conversion to an open procedure. Two (3.0%) patients had intraoperative cardiac-related complications. Postoperatively, 13.4% of patients required additional cardiac intervention unrelated to scheduled cardiac repairs, while 13.4% had fundoplication/GT complications prior to hospital discharge (Table 2). 22 (32.8%) patients had mechanical issues related to GTs, most commonly leaking (22.4%). Ten (14.9%) patients required at least one readmission for feeding concerns at a median of 8 months post-operatively [3.5 - 20.3]. Fifty-three patients (79.1%) survived to time of current study. Long-term complications included need for fundoplication revision (9.0%), readmission for aspiration pneumonia (6.0%), and need for GT conversion to gastrojejunostomy (GJ) (16.4%). Median time from Nissen to GJ conversion was 9 months [3-20 months].  At most recent follow up, 23.9% of were fed by mouth (PO), 40.3% PO+GT, 25.3% GT only, and 10.4% via GJ.

Conclusion: Infants with structural CHD undergoing anti-reflux procedures are a high-risk surgical group. This study demonstrates overall positive long-term outcomes and low complication rates in patients undergoing laparoscopic fundoplication and support safety and efficacy for offering fundoplication in selected patients.