Feasibility, Safety, and Short‐Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High‐Frequency Jet Ventilation

Abstract

Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure. Methods and Results This is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P <0.05) and no increased risk of adverse respiratory outcomes. Conclusions Transcatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.

Transport and Anaesthesia Consideration for Transcatheter Patent Ductus Arteriosus Closure in Premature Infants

“…Based on the RBH Cath Lab audit, the median duration of 165 TCPC procedures performed in the Cath Lab was 138 min (IQR 115–165 min), with a minimum of 55 min. These durations align with other facilities reporting median Cath Lab time of 109–121 min, procedure time of 28–32 min, and fluoroscopy time of 4–6 min [ 12 , 13 ]. Therefore, allocating a total case time of up to 3 h is reasonable, considering both the procedure time and transport time between the NICU and the Cath Lab.…”

“…Some ELGAN infants are in the NICU on the High-Frequency Oscillatory Ventilator (HFOV) or High-Frequency Jet Ventilator (HFJV). A study has shown that these ventilators can be used successfully in the Cath Lab for TCPC [ 12 ]. Other authors had suggested a trial off HFOV/HFJV and onto a conventional ventilator for the ease of transport the day before the procedure, only if the patient tolerates it [ 4 ].…”

Who Still Gets Ligated? Reasons for Persistence of Surgical Ligation of the Patent Ductus Arteriosus Following Availability of Transcatheter Device Occlusion for Premature Neonates

“…Ultimately, to expand access to this beneficial procedure, we feel both options are areas of future growth. Additionally, the use of high-frequency ventilation strategies was once thought to be a barrier to performing any definitive closure techniques, but recent evidence has shown that device closure of the PDA in an infant supported by high-frequency jet ventilation is feasible and safe [28]. This could potentially increase the number of patients eligible for device closure, however, it is worth noting that no infants were excluded from device closure in our study due to high-frequency ventilation.…”

The Transcatheter Closure of Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants: Technique and Results

“…Transcatheter PDA closure is usually performed in the cardiac catheterization laboratory under general anesthesia, with the patient connected to his/her own ventilator. High-frequency jet ventilation, when required, does not compromise the device placement success rate [25]. The procedure is performed using both biplane fluoroscopic and transthoracic echocardiographic guidance.…”