Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation

Hazeem, Anas Abu; Gillespie, Matthew J.; Thun, Haley; Munson, David; Schwartz, Matthew C.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

doi:10.1002/ccd.25032

Cited by 53 publications

(52 citation statements)

References 23 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: 88%

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

Backes

Cheatham

Deyo

et al. 2016

JAHA

110

111

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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: 88%

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

Backes

Cheatham

Deyo

et al. 2016

JAHA

110

111

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“…Many neonatologists would rather forego SLP if medical therapy fails . However, a hemodynamically significant PDA in the presence of underlying CLD prolongs the need for respiratory support, causes left heart failure, early onset pulmonary hypertension, prolonging hospitalization, and the associated morbidities.…”

Section: Introductionmentioning

confidence: 99%

Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants

Sathanandam

Balduf

Chilakala

et al. 2018

Cathet Cardio Intervent

101

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Background Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. Methods A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity‐score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post‐procedure and the time taken for return to pre‐procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. Results Eighty ELBW infants (median procedure weight: 1060 [range 640–2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650–1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre‐procedural scores post‐SLP compared to post‐TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30‐days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2–9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5–4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. Conclusions TCPC is feasible in infants as small as 640‐2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.

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“…Though the transcatheter reported outcomes in preterm infants are promising, they have not been directly compared with surgical outcomes in prospective trials. Recent retrospective studies comparing percutaneous PDA closure versus surgical ligation showed that preterm infants with transcatheter PDA occlusion have faster improvement in respiratory function . Patients undergoing surgical ligation at the same time period, and reportedly with similar characteristics, had higher overall morbidity including a high incidence of recurrent laryngeal nerve palsy (17%).…”

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

Congenital Heart Disease

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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.

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Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation

Abstract: Percutaneous closure of PDA in small infants on respiratory support is equivalent in safety and efficacy and may offer shorter recovery time than surgical ligation.

Cited by 53 publications

References 23 publications

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

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

Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants

Overview of transcatheter patent ductus arteriosus closure in preterm infants

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