A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology

Zahn, Evan M.; Nevin, Phillip; Simmons, Charles F.; Garg, Ruchira

doi:10.1002/ccd.25534

Cited by 96 publications

(119 citation statements)

References 27 publications

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“…Similar to previous reports,16, 31 the majority of infants in the present cohort underwent percutaneous PDA closure using an AVP‐II device. Potential benefits of the AVP‐II device are that the disks on either end of the device have the same diameter as the central occlusion portion, which may reduce rates of aortic or pulmonary blood flow disturbances more effectively than do other devices 16.…”

Section: Discussionsupporting

confidence: 87%

“…Potential benefits of the AVP‐II device are that the disks on either end of the device have the same diameter as the central occlusion portion, which may reduce rates of aortic or pulmonary blood flow disturbances more effectively than do other devices 16. However, we identified 5 cases of unsuccessful PDA closure, wherein the terminal ends of the device interfered with aortic or pulmonary artery blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence on the risks of drug therapy or surgical PDA ligation26, 27 has led to growing interest in the use of percutaneous closure in premature infants 10, 15, 16, 28, 29, 30. The main finding of our 10‐year study is that, among a large cohort of infants born very premature and referred for percutaneous closure at weights <4 kg, the majority are successfully closed in the catheterization suite with evidence of improved pulmonary status following closure, but risk of arterial injury in these infants is noteworthy.…”

Section: Discussionmentioning

confidence: 99%

“…Since arterial access was obtained in all infants in the present study, approaches that limit or avoid arterial access will likely reduce AAIs. Zahn et al recently described an approach to percutaneous PDA closure using fluoroscopy and transthoracic echocardiography to guide transvenous PDA closure with the avoidance of arterial access 16. Other investigators have reported similar success in avoiding arterial access without evidence of device embolization or malposition 30.…”

Section: Discussionmentioning

confidence: 99%

“…Although an exact lower weight limit for the safe closure of a PDA has not been established, previous studies have excluded preterm infants <4 kg or reported no cases of percutaneous PDA closure below this weight threshold 11, 12, 13, 14. While recent case reports suggest catheter‐based PDA closure is feasible among infants <4 kg,15, 16 data on the safety of the procedure, including adverse events beyond the immediate catheterization period (eg, posthospitalization), are lacking 17. Since very premature infants <4 kg are more complex and medically fragile than are their more mature counterparts,18 a separate consideration of the short‐ and long‐term risks and benefits of percutaneous PDA closure in this unique subgroup is needed.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

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BackgroundPercutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg.Methods and ResultsRetrospective analysis (January 2005–January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2–3.9 kg) underwent attempted PDA closure. Twenty‐five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01).ConclusionsAmong infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%