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

Carl H Backes, Sharon L Cheatham, Grace M Deyo, Scott Leopold, Molly K Ball, Charles V Smith, Vidu Garg, Ralf J Holzer, John P Cheatham, Darren P Berman, Carl H Backes, Sharon L Cheatham, Grace M Deyo, Scott Leopold, Molly K Ball, Charles V Smith, Vidu Garg, Ralf J Holzer, John P Cheatham, Darren P Berman

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.

Keywords: arterial thrombosis; catheterization; complications; ductus arteriosus, patent; neonatal; pediatrics.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Angiographic still frames in lateral projection illustrating percutaneous closure of PDA in a premature infant. A, Type C PDA in a 1.6‐kg infant. White arrows outline length of the PDA. B, Angiographic parameters used to define PDA classification and guide closure; A, aortic ampulla; B, narrowest dimension; C, PDA size at insertion into pulmonary artery; D, PDA length. C, Aortic angiogram following deployment of a 6‐mm AVP‐II plug. PDA indicates patent ductus arteriosus.
Figure 2
Figure 2
A, Pulmonary Score pre‐ and post–cardiac catheterization. X‐axis represents time (days), with negative values denoting days prior to catheterization. Y‐axis designates Pulmonary Scores (mean±SD) compared to precatheterization trends; Pulmonary Scores decreased following PDA closure (linear mixed‐effect model, P<0.01). B, Proportion of neonates on mechanical ventilation pre‐ and postcatheterization. X‐axis represents time (days), with negative values denoting days prior to catheterization. Y‐axis designates proportion (%) of neonates on mechanical ventilation. Compared to precatheterization trends, the likelihood to receive mechanical ventilation following PDA closure decreased (mixed‐effects logistic model, P<0.01). PDA indicates patent ductus arteriosus.

References

    1. Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population‐based study. J Pediatr Gastroenterol Nutr. 2005;40:184–188.
    1. Sellmer A, Bjerre JV, Schmidt MR, McNamara PJ, Hjortdal VE, Host B, Bech BH, Henriksen TB. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal Ed. 2013;98:F505–F510.
    1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890–1900.
    1. Bose CL, Laughon MM. Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. 2007;92:F498–F502.
    1. Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, Sekar K. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics. 2009;123:e138–e144.
    1. Weisz DE, McNamara PJ. Patent ductus arteriosus ligation and adverse outcomes: causality or bias? J Clin Neonatol. 2014;3:67–75.
    1. Heuchan AM, Clyman RI. Managing the patent ductus arteriosus: current treatment options. Arch Dis Child Fetal Neonatal Ed. 2014;99:F431–F436.
    1. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics. 2010;125:1020–1030.
    1. Janz‐Robinson EM, Badawi N, Walker K, Bajuk B, Abdel‐Latif ME; Neonatal Intensive Care Units N . Neurodevelopmental outcomes of premature infants treated for patent ductus arteriosus: a population‐based cohort study. J Pediatr. 2015;167:1025–1032.
    1. Dimas VV, Takao C, Ing FF, Mattamal R, Nugent AW, Grifka RG, Mullins CE, Justino H. Outcomes of transcatheter occlusion of patent ductus arteriosus in infants weighing </= 6 kg. JACC Cardiovasc Interv. 2010;3:1295–1299.
    1. Kumar RK, Anil SR, Kannan BR, Philip A, Sivakumar K. Bioptome‐assisted coil occlusion of moderate‐large patent ductus arteriosus in infants and small children. Catheter Cardiovasc Interv. 2004;62:266–271.
    1. Bruckheimer E, Godfrey M, Dagan T, Levinzon M, Amir G, Birk E. The Amplatzer Duct Occluder II Additional Sizes device for transcatheter PDA closure: initial experience. Catheter Cardiovasc Interv. 2014;83:1097–1101.
    1. Al‐Hamash SM, Wahab HA, Khalid ZH, Nasser IV. Transcatheter closure of patent ductus arteriosus using ado device: retrospective study of 149 patients. Heart Views. 2012;13:1–6.
    1. Knirsch W, Haas NA, Lewin MA, Dahnert I, Kececioglu D, Berger F, et al. Percutanous closure of patent ductus arteriosus in small infants of less than 8 kg body weight using different devices. Eur J Pediatr. 2004;163:619–621.
    1. Roberts P, Adwani S, Archer N, Wilson N. Catheter closure of the arterial duct in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2007;92:F248–F250.
    1. Zahn EM, Nevin P, Simmons C, Garg R. A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology. Catheter Cardiovasc Interv. 2015;85:240–248.
    1. El‐Said HG, Bratincsak A, Foerster SR, Murphy JJ, Vincent J, Holzer R, Porras D, Moore J, Bergersen L. Safety of percutaneous patent ductus arteriosus closure: an unselected multicenter population experience. J Am Heart Assoc. 2013;2:e000424 doi: .
    1. Brotschi B, Hug MI, Kretschmar O, Rizzi M, Albisetti M. Incidence and predictors of cardiac catheterisation‐related arterial thrombosis in children. Heart. 2015;101:948–953.
    1. Bergersen L, Gauvreau K, Foerster SR, Marshall AC, McElhinney DB, Beekman RH III, Hirsch R, Kreutzer J, Balzer D, Vincent J, Hellenbrand WE, Holzer R, Cheatham JP, Moore JW, Burch G, Armsby L, Lock JE, Jenkins KJ. Catheterization for congenital heart disease adjustment for risk method (CHARM). JACC Cardiovasc Interv. 2011;4:1037–1046.
    1. Bergersen L, Giroud JM, Jacobs JP, Franklin RC, Beland MJ, Krogmann ON, Aiello VD, Colan SD, Elliott MJ, Gaynor JW, Kurosawa H, Maruszewski B, Stellin G, Tchervenkov CI, Walters HL, Weinberg P, Everett AD. Report from the International Society for Nomenclature of Paediatric and Congenital Heart Disease: cardiovascular catheterisation for congenital and paediatric cardiac disease (part 2—nomenclature of complications associated with interventional cardiology). Cardiol Young. 2011;21:260–265.
    1. Krichenko A, Benson LN, Burrows P, Moes CAF, Mclaughlin P, Freedom RM. Angiographic classification of the isolated, persistently patent ductus‐arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol. 1989;63:877–880.
    1. Delaney JW, Fletcher SE. Patent ductus arteriosus closure using the Amplatzer (R) vascular plug II for all anatomic variants. Catheter Cardiovasc Interv. 2013;81:820–824.
    1. Madan A, Brozanski BS, Cole CH, Oden NL, Cohen G, Phelps DL. A pulmonary score for assessing the severity of neonatal chronic lung disease. Pediatrics. 2005;115:e450–e457.
    1. Benaron DA, Benitz WE. Maximizing the stability of oxygen delivered via nasal cannula. Arch Pediatr Adolesc Med. 1994;148:294–300.
    1. Hislop AA, Wigglesworth JS, Desai R, Aber V. The effects of preterm delivery and mechanical ventilation on human lung growth. Early Human Dev. 1987;15:147–164.
    1. Natarajan G, Chawla S, Aggarwal S. Short‐term outcomes of patent ductus arteriosus ligation in preterm neonates: reason for concern? Am J Perinatol. 2010;27:431–437.
    1. Teixeira LS, Shivananda SP, Stephens D, Van Arsdell G, McNamara PJ. Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention. J Perinatol. 2008;28:803–810.
    1. Bruckheimer E, Godfrey M, Dagan T, Levinzon M, Amir G, Birk E. The Amplatzer Duct Occluder II additional sizes device for transcatheter PDA closure: initial experience. Catheter Cardiovasc Interv. 2014;83:1097–1101.
    1. Sungur M, Karakurt C, Ozbarlas N, Baspinar O. Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer Duct Occluder II additional sizes: multicenter study. Catheter Cardiovasc Interv. 2013;82:245–252.
    1. Bentham J, Meur S, Hudsmith L, Archer N, Wilson N. Echocardiographically guided catheter closure of arterial ducts in small preterm infants on the neonatal intensive care unit. Catheter Cardiovasc Interv. 2011;77:409–415.
    1. Abu Hazeem AA, Gillespie MJ, Thun H, Munson D, Schwartz MC, Dori Y, Rome JJ, Glatz AC. Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation. Catheter Cardiovasc Interv. 2013;82:526–533.
    1. Laughon M, Bose C, Benitz WE. Patent ductus arteriosus management: what are the next steps? J Pediatr. 2010;157:355–357.
    1. Glatz AC, Shah SS, McCarthy AL, Geisser D, Daniels K, Xie D, Hanna BD, Grundmeier RW, Gillespie MJ, Rome JJ. Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single‐center cohort study. Catheter Cardiovasc Interv. 2013;82:454–462.
    1. Bratincsak A, Moore JW, El‐Said HG. Low dose tissue plasminogen activator treatment for vascular thrombosis following cardiac catheterization in children: a single center experience. Catheter Cardiovasc Interv. 2013;82:782–785.
    1. Baruteau AE, Hascoet S, Baruteau J, Boudjemline Y, Lambert V, Angel CY, Belli E, Petit J, Pass R. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis. 2014;107:122–132.
    1. Kenny D, Morgan GJ, Bentham JR, Wilson N, Martin R, Tometzki A, Oslizlok P, Walsh KP. Early clinical experience with a modified Amplatzer Ductal Occluder for transcatheter arterial duct occlusion in infants and small children. Catheter Cardiovasc Interv. 2013;82:534–540.
    1. Abdelbasit MA, Alwi M, Kandavello G, Che Mood M, Samion H, Hijazi ZM. The new Occlutech(R) PDA occluder: initial human experience. Catheter Cardiovasc Interv. 2015;86:94–99.
    1. Wang JK, Wu MH, Lin MT, Chiu SN, Chen CA, Chiu HH. Transcatheter closure of moderate‐to‐large patent ductus arteriosus in infants using Amplatzer Duct Occluder. Circ J. 2010;74:361–364.
    1. Backes CH, Cua C, Kreutzer J, Armsby L, El‐Said H, Moore JW, Gauvreau K, Bergersen L, Holzer RJ. Low weight as an independent risk factor for adverse events during cardiac catheterization of infants. Catheter Cardiovasc Interv. 2013;82:786–794.
    1. Fischer HS, Buhrer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta‐analysis. Pediatrics. 2013;132:E1351–E1360.
    1. Masri S, El Rassi I, Arabi M, Tabbakh A, Bitar F. Percutaneous closure of patent ductus arteriosus in children using Amplatzer Duct Occluder II: relationship between PDA type and risk of device protrusion into the descending aorta. Catheter Cardiovasc Interv. 2015;86:E66–E72.
    1. Mourani PM, Sontag MK, Younoszai A, Miller JI, Kinsella JP, Baker CD, Poindexter BB, Ingram DA, Abman SH. Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2015;191:87–95.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner