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Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications.
J Am Heart Assoc. 2016 Feb 12; 5(2)JA

Abstract

BACKGROUND

Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg.

METHODS AND RESULTS

Retrospective analysis (January 2005-January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2-3.9 kg) underwent attempted PDA closure. Twenty-five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01).

CONCLUSIONS

Among infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.

Authors+Show Affiliations

Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH carl.backesjr@nationwidechildrens.org.Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.The Heart Center, Nationwide Children's Hospital, Columbus, OH.Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH The Heart Center, Nationwide Children's Hospital, Columbus, OH Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26873689

Citation

Backes, Carl H., et al. "Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications." Journal of the American Heart Association, vol. 5, no. 2, 2016.
Backes CH, Cheatham SL, Deyo GM, et al. Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications. J Am Heart Assoc. 2016;5(2).
Backes, C. H., Cheatham, S. L., Deyo, G. M., Leopold, S., Ball, M. K., Smith, C. V., Garg, V., Holzer, R. J., Cheatham, J. P., & Berman, D. P. (2016). Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications. Journal of the American Heart Association, 5(2). https://doi.org/10.1161/JAHA.115.002923
Backes CH, et al. Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications. J Am Heart Assoc. 2016 Feb 12;5(2) PubMed PMID: 26873689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications. AU - Backes,Carl H, AU - Cheatham,Sharon L, AU - Deyo,Grace M, AU - Leopold,Scott, AU - Ball,Molly K, AU - Smith,Charles V, AU - Garg,Vidu, AU - Holzer,Ralf J, AU - Cheatham,John P, AU - Berman,Darren P, Y1 - 2016/02/12/ PY - 2016/2/14/entrez PY - 2016/2/14/pubmed PY - 2017/1/11/medline KW - arterial thrombosis KW - catheterization KW - complications KW - ductus arteriosus, patent KW - neonatal KW - pediatrics JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 5 IS - 2 N2 - BACKGROUND: Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg. METHODS AND RESULTS: Retrospective analysis (January 2005-January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2-3.9 kg) underwent attempted PDA closure. Twenty-five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01). CONCLUSIONS: Among infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/26873689/Percutaneous_Patent_Ductus_Arteriosus__PDA__Closure_in_Very_Preterm_Infants:_Feasibility_and_Complications_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.115.002923?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -