Follow-up after Percutaneous Patent Ductus Arteriosus Occlusion in Lower Weight Infants

Abstract

Objectives: To describe longer term outcomes for infants <6 kg undergoing percutaneous occlusion of the patent ductus arteriosus (PDA).

Study design: This was a retrospective cohort study of infants <6 kg who underwent isolated percutaneous closure of the PDA at a single, tertiary center (2003-2017). Cardiopulmonary outcomes and device-related complications (eg, left pulmonary artery obstruction) were examined for differences across weight thresholds (very low weight, <3 kg; low weight, 3-<6 kg). We assessed composite measures of respiratory status during and beyond the initial hospitalization using linear mixed effects models.

Results: In this cohort of lower weight infants, 92 of 106 percutaneous occlusion procedures were successful. Median age and weight at procedure were 3.0 months (range, 0.5-11.1 months) and 3.7 kg (range, 1.4-5.9 kg), respectively. Among infants with pulmonary artery obstruction on initial postprocedural echocardiograms (n = 20 [22%]), obstruction persisted through hospital discharge in 3 infants. No measured variables were associated with device-related complications. Rates of oxygenation failure (28% vs 8%; P < .01) and decreased left ventricular systolic function (29% vs 5%; P < .01) were higher among very low weight than low weight infants. Pulmonary scores decreased (indicating improved respiratory status) following percutaneous PDA closure.

Conclusions: Percutaneous PDA occlusion among lower weight infants is associated with potential longer term improvements in respiratory health. Risks of device-related complications and adverse cardiopulmonary outcomes, particularly among very low weight infants, underscore the need for continued device modification. Before widespread use, clinical trials comparing percutaneous occlusion vs alternative treatments are needed.

Keywords: infant; patent ductus arteriosus; percutaneous (catheter-based) treatment.

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Figure 1:

Flowchart of patient selection for inclusion.

Figure 2:

(A) Incidence of LPA obstruction observed over time; (B). Incidence of DA obstruction observed over time. “Late-onset” obstruction was defined as evidence of LPA or DA obstruction not observed on the initial post-procedure echocardiogram, but observed on subsequent imaging. The number of infants evaluated across the time points includes: pre-procedure (N=92), ≥1-month post-procedure (N=90), discharge or latest follow-up (N=89).

Figure 3:

(A): Among VLW infants, compared with pre-procedure values (70.0%), LVEF deceased immediately post procedure (VLW infants, 58.5%, P <0.01; LW infants), but returned to baseline values at discharge or longest follow-up (69.1%, P=0.58). (B) Among LW infants, compared with pre-procedure values (72.5%), LVEF deceased immediately post-procedure (67.1%, P <0.01), but returned to baseline values at discharge or longest follow-up (70.9%, P=0.24). (C) Compared with pre-procedure values, the decrease in LVEF immediately postprocedure was greater among VLW infants (11.4%) than LW infants (5.4%, P <0.01).

Figure 4:

X-axis represents time (days), with negative values denoting days prior to procedure. Y-axis designates outcomes of interest. (A) Pulmonary Score; linear mixed effects models with Dunnett’s correction for multiple comparisons over time in the Pulmonary Scores of the cohort before and after catheterization. *Adjusted P<0.01). (B) Compared with pre-procedure baseline (−2 days = 2 days before procedure) the proportion of infants on mechanical ventilation following PDA closure decreased (logistic mixed effects model, *Adjusted P<0.01). (C) Compared with pre-procedure baseline (−2 days = 2 days before procedure) the proportion of using diuretics following PDA closure decreased (logistic mixed effects model, *Adjusted P<0.01). Diuretics included furosemide, bumetanide, chlorothiazide, hydrochlorothiazide, and spironolactone.