Overview of transcatheter patent ductus arteriosus closure in preterm infants

Almeida-Jones, Myriam; Tang, Nai Yu; Reddy, Aneela; Zahn, Evan M.

doi:10.1111/chd.12712

Cited by 35 publications

(26 citation statements)

References 34 publications

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“…Transcatheter closure at the bedside under echocardiography guidance-only has also been reported ( 44 ). Unfortunately, bedside procedure under echocardiography guidance has to be performed via trans-arterial route (femoral route) without fluoroscopy which carries increased risk of potentially severe life-threatening complications such as limb ischemia and more worryingly it has limited management options for disc embolization if it occurs ( 56 ). Hence, despite technical feasibility it is almost never performed on bedside in ELBW infants and smallest reported infant having this procedure successfully done was around 1,400 g. In comparison, when percutaneous PDA closure performed in in the catheter lab it has been performed successfully in infants as small as 700 g ( 50 – 52 ).…”

Section: Patient Selection and Organization Of The Proceduresmentioning

confidence: 99%

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

et al. 2020

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Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA-when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early-and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.

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Section: Patient Selection and Organization Of The Proceduresmentioning

confidence: 99%

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

et al. 2020

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“…14 On the one hand, PDA-HS has been associated with serious comorbidities, 3,4 however, closure methods, regardless of the type of method, also come with risks. 12,15,16 There is not always a consensus as to what gives the best prognosis for newborns, whether to wait or to close the DA. Sathanandam et al 17 , through a survey study, concluded that pediatric cardiologists are more in favor of the benefits of closure of the DA than neonatologists.…”

Section: Discussionmentioning

confidence: 99%

“…It is a closure method that is already widely used in older children, even considered as a first line above 6 kg. 12 In 2011, Bentham et al 10 reported a new echo-guided closure technique in newborns with very low birth weight. As a result, this closure method has become an increasingly valid option for premature NBs, with a reported success rates of over 80%.…”

Section: Discussionmentioning

confidence: 99%

“…1 The approach and treatment of PDA have evolved in recent years using pharmacological, [6][7][8] surgical 9 and transcatheter closure methods. [10][11][12] The primary objective of this study was to evaluate the modification of the number and methods of DA closure in premature newborns over the years, at the Differential Perinatal Support Unit (Unidade de Apoio Perinatal Diferenciado -UAPD) of a level three maternity hospital, over a period of 16 years. As secondary objectives, with this sample of premature infants, it was possible to measure the success rates of closure with indomethacin and ibuprofen and assess associations with hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

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Patent Ductus Arteriosus Closure: Experience From a Tertiary Referral Center

Faim

Tiago

Castelo

et al. 2021

Rev. paul. pediatr.

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Objective: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital. Methods: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored. Results: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001). Conclusions: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.

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“…Inhaled nitric oxide also contributed to the bleeding because the exposure of nitric oxide might lead to a certain degree of coagulopathy (27). Transcatheter PDA closure in preterm infants has become an available intervention and several trials presented promising outcomes (28,29). The hemodynamic study can be measured during the cardiac catheterization, which even allows a test occlusion before PDA closure in pre-term infants with a bidirectional shunt.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern

Yang

Liu

et al. 2020

Front. Pediatr.

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Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA. Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups. Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05). Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary Yang et al. PDA Ligation in Pre-term Infants hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.

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Overview of transcatheter patent ductus arteriosus closure in preterm infants

Cited by 35 publications

References 34 publications

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams

Patent Ductus Arteriosus Closure: Experience From a Tertiary Referral Center

Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern

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