Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis

Preterm infants are at increased risk for patent ductus arteriosus (PDA). Prolonged exposure to PDA may be deleterious and has been associated with neonatal morbidity and mortality. Although the molecular mechanisms underlying regulation of postnatal ductus arteriosus closure are not fully understood, clinical experience and research trials have informed recent changes in PDA management strategies and refocused treatment strategies on smaller subsets of infants who require intervention. This review examines current diagnostic and management approaches to PDA in preterm neonates.

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“…Trials are under way with products in development to accomplish catheter-based PDA closure in smaller patients. (55)…”

Section: Ligationmentioning

confidence: 99%

Diagnosis and Management of Patent Ductus Arteriosus

Gillam-Krakauer

Reese

2018

NeoReviews

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“…For the reasons discussed above, this technology has not been widely adopted for the ELBW population to date. There is data to suggest that ELBW and younger infants <30 days have increased procedure‐related adverse events despite high PDA closure rates . Therefore, operators are still looking to improve transcatheter PDA closure techniques and outcomes in smaller infants and children, particularly when the alternative treatment modalities are suboptimal.…”

Section: Transcatheter Pda Occlusion Techniques In Smaller Patients: mentioning

confidence: 99%

“…A meta‐analysis of percutaneous PDA closure in infants was performed in 2017 comparing 38 studies and 635 procedures . Of these, 19% of patients weighed <3 kg ( n = 103) and 48% ( n = 255) weighed 3‐6 kg at the time of the procedure.…”

Section: Transcatheter Pda Occlusion Techniques In Smaller Patients: mentioning

confidence: 99%

“…However, this modality has not been routinely used in ELBW infants due to concerns regarding overall medical fragility, fear of increased incidence of procedure‐related adverse events, technical challenges involved in catheterizing extremely small patients and the absence of a suitable device for this application. Recently, however, there has been an emergence of several reports of successful transcatheter PDA closure in ELBW infants, which serves as the primary basis for this review …”

Section: Introductionmentioning

confidence: 99%

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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 the PDA is among the safest of interventional cardiac procedures and is considered to be the procedure of choice for PDA closure beyond infancy (≥5 kg) . Robust evidence among older and more mature patients has led investigators to study the feasibility and safety profile of catheter‐based interventions to close the PDA during infancy . Over the past decade, our institution (Nationwide Children’s Hospital, NCH) has undergone a marked shift away from surgical PDA ligation, and currently emphasizes conservative management (described below) followed by percutaneous closure for infants needing definitive ductal closure (Figure ) .…”

Section: Introductionmentioning

confidence: 99%

Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

Mitchell

Rivera

Cooper

et al. 2019

Congenital Heart Disease

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The optimal treatment method for infants with a patent ductus arteriosus (PDA) necessitating closure remains a subject of controversy and debate. While the risks associated with surgical PDA ligation are well described, the available evidence base for alternative management strategies during infancy, including percutaneous closure or conservative (nonintervention) management, are not well explored. Among infants, the goals of this review are to: (a) use rigorous systematic review methodology to assess the quality and quantity of published reports on percutaneous closure vs surgical ligation; (b) compare outcomes of percutaneous closure vs conservative management; and (c) based on recommendations from the International PDA symposium, to elucidate needs and opportunities for future research and interdisciplinary collaboration. The available evidence base, as well as on broad consensus reached at the International PDA Symposium, suggests that a contemporary, pragmatic clinical trial comparing PDA treatment strategies is warranted. Additionally, quality assurance safeguards are necessary in the implementation of newer PDA closure devices. Finally, to determine best approaches to treatment for infants with PDA, tools for consistent data collection and reporting across centers and disciplines are needed to minimize heterogeneity and permit pooled analysis.

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Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis

Abstract: Percutaneous PDA closure during infancy is feasible and associated with few catastrophic AEs; however, the limitations constrain the interpretability and generalizability of the current findings.

Cited by 77 publications

References 76 publications

Diagnosis and Management of Patent Ductus Arteriosus

Diagnosis and Management of Patent Ductus Arteriosus

Overview of transcatheter patent ductus arteriosus closure in preterm infants

Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

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