Transcatheter Occlusion of the Patent Ductus Arteriosus in 747 Infants &lt;6 kg

Backes, Carl H.; Kennedy, Kevin F.; Locke, Megan; Clifford, L.; Ball, Molly K.; Fick, Tyler A.; Rivera, Brian K.; Smith, Charles V.; Holzer, Ralf; Boe, Brian A.; Berman, Darren P.; Bergersen, Lisa; Armstrong, Aimee K.

doi:10.1016/j.jcin.2017.05.018

Cited by 52 publications

(50 citation statements)

References 23 publications

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“…Many cardiologists and neonatologists are concerned about the technical issues of performing TCPC in extremely small infants. Concerns still include femoral arterial trauma, though this vessel is not utilized for access . Other concerns include stenosis of the aorta or the left pulmonary artery and device embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Incidences of necrotizing enterocolitis (NEC), chronic lung disease (CLD), and intraventricular hemorrhage (IVH) are associated with PDA, as pulmonary over circulation occurs and systemic circulation is hypoperfused . Management practices can vary from watchful waiting for closure, medical therapy with Cox inhibitors, surgical ligation, and transcatheter PDA closure (TCPC) . This article presents some of the considerations which determine the modality and timing of PDA treatment, if any, from a sample of 100 prominent cardiologists and neonatologists in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Survey results among cardiologists and neonatologists

Sathanandam

Whiting

Cunningham

et al. 2019

Congenital Heart Disease

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Background Patent ductus arteriosus (PDA) is highly prevalent in extremely low birth weight (ELBW), preterm infants. There are diverse management approaches for the PDA in ELBW infants. The objectives of this research were to identify current PDA management practices among cardiologists and neonatologists in the United States, describe any significant differences in management, and describe areas where practices align. Methods A survey of 10 questions based on the management of PDA in ELBW infants was conducted among 100 prominent neonatologists from 74 centers and 103 prominent cardiologists from 75 centers. Among the cardiologists, approximately 50% were interventionists who perform transcatheter PDA closures (TCPC). Fisher’s exact test was performed to compare practice variations among neonatologists and cardiologists. A potentially biased audience including a combination of health care providers belonging to cardiology, neonatology, and surgery were also surveyed during the International PDA Symposium. The results of this survey were not included for statistical comparison, due to this audience being potentially influenced by the Symposium. Results Statistically significant differences were identified between neonatologists and cardiologists regarding the impact of PDA closure on morbidity and mortality, with 80% cardiologists responding that it does vs 54% of neonatologists (P < 0.001), the need for PDA closure (P < .001), and the preferred method of PDA closure if indicated (P < .001). There was agreement between neonatologists and cardiologists on symptomatic therapy; however more neonatologists favored watchful waiting over intervention in contrast to more cardiologists favoring intervention over observation (77% vs 95%, P < .001). Survey responses also identified a need for further training and research on TCPC. Conclusion Neonatologists and cardiologists have notable differences in managing PDA, and continued discussion across cardiology and neonatology has the potential to facilitate more of a consensus on best management practices. Further investigation is needed to identify outcomes in transcatheter PDA closure, particularly in ELBW infants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Survey results among cardiologists and neonatologists

Sathanandam

Whiting

Cunningham

et al. 2019

Congenital Heart Disease

View full text Add to dashboard Cite

show abstract

“…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%

“…Major adverse events were noted in 12.6% of the cases. Infants younger than 30 days had greater risk of major adverse events (relative risk 3.3, confidence interval 1.46‐7.64) …”

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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“…Additional concerns are prolonged procedure time and increased radiation and intravenous contrast dose in an already fragile patient. Percutaneous PDA closure has typically been reserved for patients older than 3 months weighing >6 kg, however, this approach is feasible in children <6 kg with currently available devices and delivery systems . Recently, reports of successful PDA occlusion under fluoroscopy or echocardiographic guidance in preterm and low birth weight neonates have been reported associated with a low complication rate .…”

Section: Specific Cardiac Lesions In Neonates and Infantsmentioning

confidence: 99%

Anesthesia for high‐risk procedures in the catheterization laboratory

Daaboul

DiNardo

Nasr

2019

Pediatric Anesthesia

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Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

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Transcatheter Occlusion of the Patent Ductus Arteriosus in 747 Infants <6 kg

Cited by 52 publications

References 23 publications

Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Survey results among cardiologists and neonatologists

Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Survey results among cardiologists and neonatologists

Overview of transcatheter patent ductus arteriosus closure in preterm infants

Anesthesia for high‐risk procedures in the catheterization laboratory

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