Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants

Self Cite

Objective Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. Design The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. Setting A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Patients To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure‐related complications. Interventions It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Outcome measures This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. Results There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure‐related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. Conclusions It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.

Section: Introductionmentioning

confidence: 99%

Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience

Sathanandam

Agrawal

Chilakala

et al. 2019

Self Cite

“…Optimal imaging is paramount while performing TCPC. Since TCPC involves no direct visualization of the PDA, the operator is dependent on fluoroscopic and echocardiographic imaging . All this equipment occupies a large space.…”

Section: Discussionmentioning

confidence: 99%

Transport of extremely low birth weight neonates for persistent ductus arteriosus closure in the catheterization lab

Willis

Pereiras

Head

et al. 2019

Self Cite

Objective The objective of this article is to describe the elements involved with transporting extremely low birth weight (ELBW) infants from referring centers to our center’s neonatal intensive care unit (NICU) and then from the NICU to the catheterization lab for transcatheter closure of patent ductus arteriosus (PDA). Setting Several referring centers are over 300 miles away. ELBW infants are transferred in to our NICU safely for the procedure and transferred back following the procedure. A multidisciplinary team approach is necessary in order to achieve a safe transport of these fragile patients. Patients To date, we have over 12 centers referring patients that weigh <1000 g for transcatheter PDA closure (TCPC). Three of these centers are over 300 miles away. Five other centers are between 100 and 300 miles from the hospital in which we perform TCPC. Interventions Fixed‐wing aircrafts are necessary for long‐distance transfers. Various modes of mechanical ventilators including transport oscillators are built into temperature‐ and humidity‐controlled incubators in which these infants are transported. Ambulances are used to take the patient between the airport and the hospital. Shorter distance transports are accomplished via helicopters or ambulances. Transfer from the NICU to the catheterization lab to perform TCPC is a relatively easier endeavor. Outcome Measures Patients’ body temperature, fluid balance, and hemodynamics have to be maintained throughout the transport and the procedure for best outcomes. Results There has been 100% procedural success of performing TCPC in ELBW infants with no hemodynamic compromise during transport. Conclusions TCPC has shown promise in improving overall patient outcomes that the potential hazards associated with complex transport measures are worth it. Successful transfer to and from referring centers and to and from the catheterization lab can be accomplished safely with increasing institutional experience.

“…More recent reports of PDA closure using Medtronic Micro Vascular Plug (MVP) in preterm infants has shown similar promising results in ELBW infants weighing less than 2000 g . Sathanandam et al described a successful, echocardiography guided, antegrade PDA occlusion approach, via femoral venous access in 12 patients with a median weight of 1210 g (range 700‐3500 g).…”

Section: Transcatheter Pda Occlusion Techniques In Smaller Patients: mentioning

confidence: 99%

Overview of transcatheter patent ductus arteriosus closure in preterm infants

Almeida-Jones

Tang

Reddy

et al. 2019

Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a comprehensive review of this emerging procedure.