Institutional Trend in Device Selection for Transcatheter PDA Closure in Premature Infants

Abstract

We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the Microvascular Plug, “MVP” (Medtronic, Minneapolis, MN); Micro Plug Set, “Micro Plug” (KA Medical, Minneapolis, MN); and Amplatzer Piccolo Occluder, “Piccolo” (Abbot, Santa Clara, CA). We also report trends in device selection over time. Studies examining outcomes according to device selection for PDA closure in premature infants are lacking. We performed a retrospective review of all percutaneous PDA closures in premature infants at a single center (June 2018–May 2021). Patients were grouped by initial device selected for PDA closure (intention to treat). Institutional Review Board approval was obtained. 58 premature infants [MVP (n = 25), Micro Plug (n = 25), and Piccolo (n = 8)] underwent successful transcatheter PDA closure (mean gestational age 27 weeks 2 days; mean weight at procedure 1.4 kg; mean age at procedure 28 days). Pre-procedural demographics, procedural data, and follow-up data were similar between groups. There were no significant procedural adverse events. Three devices (2 MVP, 0 Micro Plug, 1 Piccolo p = 0.27) embolized after the procedure. One other device was removed for concern for aortic obstruction. Device selection evolved with a clear trend toward the Micro Plug device over time. Demographic, procedural, and follow-up data were similar between the MVP, Micro Plug, and Piccolo groups. The Micro Plug did not require exchange for suboptimal fitting or embolize and became our preferred device in most cases.

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

“…Since the initial coil occlusion of preterm PDA [16], a few devices have been used successfully to percutaneously close PDAs in ELBW and VLBW infants, including the Amplatzer Vascular Plug II (AVP II, Abbott, Santa Clara, CA, USA) [17][18][19][20], the Amplatzer Vascular Plug IV (AVP IV, Abbott) [21], the Micro Vascular Plug (MVP, Medtronic, Minneapolis, MN, USA) [22], the Micro Plug Set (Micro Plug, KA Medical, Minneapolis, MN, USA) [23,24] and the Amplatzer Duct Occluder II Additional Sizes (ADOIIAS), renamed as Amplatzer Piccolo Occluder (APO, Abbott) after the seminal US clinical trial [10]. However, the lengths of both AVP-II and AVP-IV may be limiting factors in increasing the risk of descending aorta and/or left pulmonary artery (LPA) obstruction.…”

“…The Micro Plug is a new microcatheter-delivered device that is currently not commercially available in the European market. Although there are limited published experiences so far, promising safety and efficacy results have been reported in 8 [23] and 25 patients [24], respectively. The APO is currently the only dedicated device for this procedure; it has a particular design for fetal ductus morphology, and an elongated-tubular PDA with a narrowing on the pulmonary side (Hockey stick morphology).…”

Transcatheter Patent Ductus Arteriosus Closure in Premature Infants: A Multicenter Retrospective Study Comparing Available Devices

“…Two other commonly used devices for transcatheter closure in premature infants (off-label use) are the Medtronic microvascular plug ([MVP]; Medtronic, MN) and the KA Medical Micro Plug (KA Medical, MN). 2 This study aimed to compare the immediate and medium-term procedural outcomes among these 3 devices.…”