Transcatheter Closure of Patent Ductus Arteriosus in Extremely Premature Newborns

Zahn, Evan M.; Peck, Daniel; Phillips, Alistair; Nevin, Phillip; Basaker, Kaylan; Simmons, Charles F.; McRae, Marion E.; Early, Tracy; Garg, Ruchira

doi:10.1016/j.jcin.2016.09.019

Cited by 107 publications

(107 citation statements)

References 29 publications

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“…Transcatheter PDA closure (TCPC) in older children (>5 kg) has been performed for over half a century and is now the standard of care. However, it should be noted that performance of this procedure in an ELBW neonate entails use of specific techniques (Table ) and devices for optimal results with low risk of complications . In this article, we describe our approach toward evaluation and transcatheter closure of PDA in ELBW neonates.…”

Section: Introductionmentioning

confidence: 99%

Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience

Sathanandam

Agrawal

Chilakala

et al. 2019

Congenital Heart Disease

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Objective Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. Design The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. Setting A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Patients To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure‐related complications. Interventions It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Outcome measures This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. Results There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure‐related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. Conclusions It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.

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Section: Introductionmentioning

confidence: 99%

Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience

Sathanandam

Agrawal

Chilakala

et al. 2019

Congenital Heart Disease

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“…When we first started to perform TCPCs in ELBW infants at our center, there were considerations to perform this procedure at the patient’s bedside in the NICU . The perils of transporting these extremely fragile patients form the NICU to the catheterization lab was unknown.…”

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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“…Percutaneous PDA closure has typically been reserved for patients older than 3 months weighing >6 kg, however, this approach is feasible in children <6 kg with currently available devices and delivery systems . Recently, reports of successful PDA occlusion under fluoroscopy or echocardiographic guidance in preterm and low birth weight neonates have been reported associated with a low complication rate . It is facilitated by the development of smaller devices designed specifically to occlude the PDA, and the possibility of downsizing sheath sizes to 3 or 4 Fr .…”

Section: Specific Cardiac Lesions In Neonates and Infantsmentioning

confidence: 99%

“…Classically, PDA occlusion is performed from a retrograde arterial approach, necessitating an arterial and venous femoral access. Techniques using solely a femoral venous access have been successfully used in preterm infants, where the guidewire is advanced through the right heart across the PDA into the descending aorta, under fluoroscopic guidance, and the device position checked by echocardiography …”

Section: Specific Cardiac Lesions In Neonates and Infantsmentioning

confidence: 99%

“…With proper patient selection, the success rate was 88% with a very low complication rate (two patients developed moderate descending aortic obstruction, resolved with device manipulation under echo guidance). Some of these procedures were also performed in the neonatal intensive care unit (NICU) with mobile mini C‐arm fluoroscopy . In addition to the avoidance of contrast media injection and the need for arterial access, this technique allows for decreased fluoroscopic time, direct assessment of the device position and detection of immediate complications by echocardiography.…”

Section: Specific Cardiac Lesions In Neonates and Infantsmentioning

confidence: 99%

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Anesthesia for high‐risk procedures in the catheterization laboratory

Daaboul

DiNardo

Nasr

2019

Pediatric Anesthesia

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Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

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Transcatheter Closure of Patent Ductus Arteriosus in Extremely Premature Newborns

Abstract: This newly described technique can be performed safely with a high success rate and minimal procedural morbidity in EPNs. Early and midterm follow-up is encouraging. Future efforts should be directed toward developing specific devices for this unique application.

Cited by 107 publications

References 29 publications

Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience

Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience

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

Anesthesia for high‐risk procedures in the catheterization laboratory

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