Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

Mitchell, Courtney; Rivera, Brian K.; Cooper, Jennifer N.; Smith, Charles V.; Berman, Darren P.; Slaughter, Jonathan L.; Backes, Carl H.

doi:10.1111/chd.12704

Cited by 19 publications

(11 citation statements)

References 31 publications

(53 reference statements)

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“…Multiple centers now report performing the vast majority of PDA closures in preterm infants using a transcatheter technique. 24 , 25 An analysis of the PHIS database between 2007 and 2017 demonstrated decreasing rates of PDA closure overall, with an increasing proportion of closures being performed by transcatheter methods. There was, however, considerable practice variation in the use of TC between institutions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children’s Hospitals

Kuntz

Staffa

Faraoni

et al. 2022

JAHA

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Background Pharmacologic therapy for patent ductus arteriosus closure is not consistently successful. Surgical ligation (SL) or transcatheter closure (TC) may be needed. Large multicenter analyses comparing outcomes and resource use between SL and TC are lacking. We hypothesized that patients undergoing TC have improved outcomes compared with SL, including mortality, hospital and intensive care unit length of stay, and mechanical ventilation. Methods and Results Using the 2016 to 2020 Pediatric Health Information System database, characteristics, outcomes, and charges of patients aged <1 year who underwent TC or SL were analyzed. A total of 678 inpatients undergoing TC (n=503) or SL (n=175) were identified. Surgical patients were younger (0.1 versus 0.53 years; P <0.001) and more premature (60% versus 20.3%; P <0.001). Surgical patients had higher mortality (1.7% versus 0%; P =0.02). Using inverse probability of treatment weighting by the propensity score, multivariable‐adjusted analyses demonstrated favorable outcomes in TC: intensive care unit admission rates (adjusted odds ratio [OR], 0.2; 95% CI, 0.11–0.32; P <0.001); mechanical ventilation rates (adjusted OR, 0.3; 95% CI, 0.19–0.56; P <0.001); and shorter hospital (adjusted coefficient, 2 days shorter; 95% CI, 1.3–2.7; P <0.001) and postoperative (adjusted coefficient, 1.2 days shorter; 95% CI, 0.1–2.3; P =0.039) stays. Overall charges and readmission rates were similar. Among premature neonates and infants, hospital (adjusted difference in medians, 4 days; 95% CI, 1.7–6.3 days; P <0.001) and postoperative stays (adjusted difference in medians, 3 days; 95% CI, 1.1–4.9 days; P =0.002) were longer for SL. Conclusions TC is associated with lower mortality and reduced length of stay compared with SL. Rates of TC continue to increase compared with SL.

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Section: Discussionmentioning

confidence: 99%

“…The approval of the Amplatzer Piccolo Occluder (Abbott, Santa Clara, CA) for infants as small as 700 g in January 2019 has presumably played a substantial role in the trend toward more TC in neonates, as well as the increasing rate of prematurity for transcatheter patients. 16 , 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children’s Hospitals

Kuntz

Staffa

Faraoni

et al. 2022

JAHA

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“…This trend was also shown in the UK/Ireland, with a substantial decline in surgical PDA closure between 2000 and 2016 and a slight decrease of transcatheter procedure during the last two years [33]. This might not only be linked to changes in AP guidelines, but also a more general reluctance whether every PDA needs always be closed, especially the very small "silent" PDA and that in preterm infants prone to spontaneous closure [24,34], where debate is still controversial [35].…”

Section: Discussionmentioning

confidence: 83%

Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

Dietrich¹,

Quandt²,

Kretschmar³

et al. 2022

Congenital Heart Disease

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Objectives: To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus (PDA) in children. Background: National antibiotic prophylaxis (AP) guideline for infective endocarditis changed after 2009, the effect on practice of PDA closure is unknown. Methods: Observational single center study analyzing follow-up of PDA closure comparing two time periods before (2002-2009) and after (2010-2019) changes in AP guideline. Results: 332 patients (68.1% female), median (interquartile range) age 3.0 years (1.5-5.7) and body weight 14.0 kg (10.0-19.3), were enrolled. PDA morphology was conical type A (50.3%), window type B (1.2%), tubular type C (40.1%), complex type D (2.1%), elongated type E (0.9%) and other (5.4%). Minimal PDA diameter and length were 1.9 mm (1.3-2.5) and 8.0 mm (6.2-10.2). PDA was closed using coils (56.3%), Amplatzer Duct Occluders (41.9%) and others (1.8%). Complete closure rate was 61.1% at catheter intervention, 72.3% on day 1, 87.7% after 6 months and 98.4% at last follow-up on echocardiography. Moderate complication rate (severity level 3) was 4.2% and major complication rate (severity level 4) 0.3%, with no catastrophic complications (severity level 5). Annual PDA closure rate declined in the second time period (22.6/year vs. 15.5/ year, p = 0.018), PDA size increased (1.6 mm vs. 2.0 mm, p = 0.002) and proportion of coils decreased (72.4% vs. 37.1%, p < 0.001). Conclusions: Interventional closure of PDA is associated with excellent closure rates during follow-up (>98%) and only a small number of complications leading to reintervention or surgery. Change in AP guidelines changed indication for and practice of PDA closure.

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“…Since PDA transcatheter closure is among the safest interventional cardiac procedure and is now considered the method of choice for PDA closure in infants above 5 kgs [ 9 ], a variety of devices have been approved for safe and effective PDA closure [ 10 ]. In our study, we achieved 95% success rate with only 5% rate of adverse events, major complications accounted for 2% (6 patients), and the rest 3% (9 patients) had minor complications in patients with minimum size of PDA 1.5 mm and maximum up to 7 mm.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of percutaneous patent ductus arteriosus closure: a multicenter Egyptian experience

et al. 2022

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Background Transcatheter closure of patent ductus arteriosus (PDA) has gained acceptance over the last two decades, replacing the surgery in more than 90% of the cases, so the safety and efficacy of transcather closure of PDA have been evaluated by studying different experiences from different centers in developing countries. The aim is to report our experience with PDA transcather closure, with focus on the adverse events and complications faced during the procedure. Results Outcome data on PDA transcatheter closure were collected from two different tertiary centers in a multicenter registry. During the period from June 2017 till January 2021, 308 PDA closure were recorded, using device in 197 (64%) and coils in 111 (36%) patients, most of the patients were in pediatric age group from 6 months to 6 years and only 10 patients (3.2%) were adults. Most patients had isolated PDA of 92%, and 9 (2.9%) patients had residual PDAs either post-surgical or transcatheter closure. Median minimum PDA diameter was 2.8 mm (range 1–7.6 mm; IQR 1.8–3.8 mm). The procedure was successful in 293 patients (95%). Complications occurred in 15/308 patients (5%), and only 6 (2%) of them were major complications, but none was life threating. Frequent complications were device embolization (2%), hemolysis (1%), arrhythmia (1%). Younger age, low body weight and longer procedure time were associated with a high complication rate (p < 0.005). Device-related complications were more common than coil-related complications (2.5% versus 0.5%). Conclusions Although transcatheter closure of PDA is considered to be effective procedure with low complications rate, however, complications should be anticipated and managed properly.

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Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

Cited by 19 publications

References 31 publications

Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children’s Hospitals

Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children’s Hospitals

Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

Safety and efficacy of percutaneous patent ductus arteriosus closure: a multicenter Egyptian experience

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