Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants

Sathanandam, Shyam; Balduf, Kaitlin; Chilakala, Sandeep; Washington, Kristen; Allen, Kimberly; Knott‐Craig, Christopher J.; Waller, B. Rush; Philip, Ranjit

doi:10.1002/ccd.27808

Cited by 99 publications

(101 citation statements)

References 30 publications

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“…In the most recent years, several cohort studies reported preliminary experience with transcatheter technique, using various devices for PDA closure in premature infants (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). Comparison with surgical ligation revealed a positive impact on post procedure pulmonary outcome (49,50). The procedure has been well-described in preterm infants, including extremely low birth weight (ELBW) infants as small as 640 g (50).…”

Section: Transcatheter Closure Of Pda In Extremely Preterm Infants: Bmentioning

confidence: 99%

“…Comparison with surgical ligation revealed a positive impact on post procedure pulmonary outcome (49,50). The procedure has been well-described in preterm infants, including extremely low birth weight (ELBW) infants as small as 640 g (50). Following the results of an ongoing prospective trial using the ADO II AS, this device received FDA and CE approval for transcatheter closure of PDA in premature babies weighting more than 700 g and over 3 days old (51).…”

Section: Transcatheter Closure Of Pda In Extremely Preterm Infants: Bmentioning

confidence: 99%

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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: Transcatheter Closure Of Pda In Extremely Preterm Infants: Bmentioning

confidence: 99%

Section: Transcatheter Closure Of Pda In Extremely Preterm Infants: Bmentioning

confidence: 99%

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

et al. 2020

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“…Optimal imaging is paramount while performing TCPC. Since TCPC involves no direct visualization of the PDA, the operator is dependent on fluoroscopic and echocardiographic imaging . All this equipment occupies a large space.…”

Section: Discussionmentioning

confidence: 99%

Transport of extremely low birth weight neonates for persistent ductus arteriosus closure in the catheterization lab

Willis

Pereiras

Head

et al. 2019

Congenital Heart Disease

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Objective The objective of this article is to describe the elements involved with transporting extremely low birth weight (ELBW) infants from referring centers to our center’s neonatal intensive care unit (NICU) and then from the NICU to the catheterization lab for transcatheter closure of patent ductus arteriosus (PDA). Setting Several referring centers are over 300 miles away. ELBW infants are transferred in to our NICU safely for the procedure and transferred back following the procedure. A multidisciplinary team approach is necessary in order to achieve a safe transport of these fragile patients. Patients To date, we have over 12 centers referring patients that weigh <1000 g for transcatheter PDA closure (TCPC). Three of these centers are over 300 miles away. Five other centers are between 100 and 300 miles from the hospital in which we perform TCPC. Interventions Fixed‐wing aircrafts are necessary for long‐distance transfers. Various modes of mechanical ventilators including transport oscillators are built into temperature‐ and humidity‐controlled incubators in which these infants are transported. Ambulances are used to take the patient between the airport and the hospital. Shorter distance transports are accomplished via helicopters or ambulances. Transfer from the NICU to the catheterization lab to perform TCPC is a relatively easier endeavor. Outcome Measures Patients’ body temperature, fluid balance, and hemodynamics have to be maintained throughout the transport and the procedure for best outcomes. Results There has been 100% procedural success of performing TCPC in ELBW infants with no hemodynamic compromise during transport. Conclusions TCPC has shown promise in improving overall patient outcomes that the potential hazards associated with complex transport measures are worth it. Successful transfer to and from referring centers and to and from the catheterization lab can be accomplished safely with increasing institutional experience.

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“…TCPC is a relatively new technique that is constantly being refined for the purpose of performing this procedure safely in ELBW infants. Among the many advantages of TCPC over medical therapy is that it guarantees definitive closure of the PDA with limited risks (as low as 3% in some reports in ELBW infants) . Since, no “cutting and stitching” of the baby is required unlike surgical ligation, it can prevent complications associated with thoracotomy including post‐ligation syndrome .…”

Section: Discussionmentioning

confidence: 99%

“…Among the many advantages of TCPC over medical therapy is that it guarantees definitive closure of the PDA with limited risks (as low as 3% in some reports in ELBW infants) . Since, no “cutting and stitching” of the baby is required unlike surgical ligation, it can prevent complications associated with thoracotomy including post‐ligation syndrome . Since this is a new therapy, awareness among neonatologists regarding the feasibility and safety of this technique is still lacking.…”

Section: Discussionmentioning

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

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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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Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants

Cited by 99 publications

References 30 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

Transport of extremely low birth weight neonates for persistent ductus arteriosus closure in the catheterization lab

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

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