Safety of Percutaneous Patent Ductus Arteriosus Closure: An Unselected Multicenter Population Experience

Abstract

BackgroundThe technique and safety of transcatheter patent ductus arteriosus (PDA) closure have evolved during the past 20 years. We sought to report a multicenter experience of PDA closure with a focus on the rate of adverse events (AE) and a review of institutional practice differences.Methods and ResultsOutcome data on transcatheter PDA closure were collected at 8 centers prospectively using a multicenter registry (Congenital Cardiac Catheterization Project on Outcome Registry). Between February 2007 and June 2010, 496 PDA closures were recorded using a device in 338 (68%) or coils in 158 (32%). Most patients had an isolated PDA (90%). Fifty percent of patients were between 6 months and 3 years old, with only 40 patients (8%) <6 months old. Median minimum PDA diameter was 2.5 mm (range 1 to 12 mm; IQR 2 to 3 mm) for device closure and 1 mm (range 0.5 to 6 mm; IQR 1 to 2 mm) for coil closure (P<0.001). A device rather than coil was used in patients <3 years, weight <11 kg, and with a PDA minimum diameter >2 mm (all P<0.001). Three of 8 centers exclusively used a device for PDAs with a diameter >1.5 mm. In 9% of cases (n=46), an AE occurred; however, only 11 (2%) were classified as high severity. Younger age was associated with a higher AE rate. Coil‐related AEs were more common than device‐related AEs (10% versus 2%, P<0.001).ConclusionsPDA closure in the present era has a very low rate of complications, although these are higher in younger children. Technical intervention‐related events were more common in coil procedures compared with device procedures. For PDAs ≤2.5 mm in diameter, institutional differences in preference for device versus coil exist.

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

“…Although an exact lower weight limit for the safe closure of a PDA has not been established, previous studies have excluded preterm infants <4 kg or reported no cases of percutaneous PDA closure below this weight threshold 11, 12, 13, 14. While recent case reports suggest catheter‐based PDA closure is feasible among infants <4 kg,15, 16 data on the safety of the procedure, including adverse events beyond the immediate catheterization period (eg, posthospitalization), are lacking 17. Since very premature infants <4 kg are more complex and medically fragile than are their more mature counterparts,18 a separate consideration of the short‐ and long‐term risks and benefits of percutaneous PDA closure in this unique subgroup is needed.…”

Self‐repositioning of an embolized patent ductus arteriosus device—a nightmare turned into sweet dreams

“…Transcatheter closure of PDA is a safe and effective alternative therapeutic modality to surgical intervention . In large PDA of infants, there is a narrow margin of safety between undersized device (embolization, residual flow) and oversized device (PA or DTA obstruction) . Device selection is crucial with respect to type and size of the device.…”

Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

“…Percutaneous closure of the PDA is among the safest of interventional cardiac procedures and is considered to be the procedure of choice for PDA closure beyond infancy (≥5 kg) . Robust evidence among older and more mature patients has led investigators to study the feasibility and safety profile of catheter‐based interventions to close the PDA during infancy .…”