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Ligon RA, Bhombal S, Adamson M, Hash S, Kim DW, LeFevre AS, Long JB, McLaughlin S, Mills M, Roddy K, Tucker L, Samai C, Piazza A, Hamrick SE. Impact of a Multidisciplinary Service Line and Program for Transcatheter Device Closure of the Neonatal Ductus Arteriosus. Pediatr Cardiol 2024:10.1007/s00246-024-03629-z. [PMID: 39196349 DOI: 10.1007/s00246-024-03629-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Abstract
Outline a quality initiative establishing an institutional service line for neonatal transcatheter device closure of the patent ductus arteriosus (TDC-PDA). A retrospective descriptive observational study surrounds programmatic approach to TDC-PDA in premature neonates with process measure spanning education, implementation, referral, and post-procedural care. Metrics tracked pre- and post-program creation with statistical analyses performed. Neonatal TDC-PDA referrals increased exponentially since program inception (n = 13 in year prior; n = 42 year 1; n = 74 year 2), especially in patients weighing less than 1.3 kg (12.5%; 55%; 50%), and were associated with an increased procedural success rate (81%; 95%; 99%). Procedural checklist creation decreased procedural "out of isolette" time (median 93 min; 59; 52), and procedural-related complication or clinical sequelae (19%; 12%; 4%). A multidisciplinary service line and program dedicated to neonatal TDC-PDA can result in a significant increase in referrals as well as procedural efficacy and safety for this medically fragile population.
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Affiliation(s)
- R Allen Ligon
- Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA.
| | - Shazia Bhombal
- Division of Neonatology, Children's Healthcare of Atlanta, Emory University School of Medicine, 316 F 3rd Floor Emory Children's Center, Atlanta, GA, 30322, USA
| | - Marissa Adamson
- Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA
| | - Sarah Hash
- Children's Healthcare of Atlanta, Atlanta, USA
| | - Dennis W Kim
- Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA
| | | | - Justin B Long
- Division of Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, USA
| | - Sarah McLaughlin
- Emory University School of Medicine, 1440 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Marcos Mills
- Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA
| | - Katie Roddy
- Division of Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, USA
| | | | - Cyrus Samai
- Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA
| | - Anthony Piazza
- Division of Neonatology, Children's Healthcare of Atlanta, Emory University School of Medicine, 316 F 3rd Floor Emory Children's Center, Atlanta, GA, 30322, USA
| | - Shannon E Hamrick
- Division of Neonatology, Children's Healthcare of Atlanta, Emory University School of Medicine, 316 F 3rd Floor Emory Children's Center, Atlanta, GA, 30322, USA
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Shibbani K, Mohammad Nijres B, McLennan D, Bischoff AR, Giesinger R, McNamara PJ, Klein J, Windsor J, Aldoss O. Feasibility, Safety, and Short‐Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High‐Frequency Jet Ventilation. J Am Heart Assoc 2022; 11:e025343. [PMID: 35574958 PMCID: PMC9238575 DOI: 10.1161/jaha.122.025343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure. Methods and Results This is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes. Conclusions Transcatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.
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Affiliation(s)
- Kamel Shibbani
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Bassel Mohammad Nijres
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Daniel McLennan
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | | | - Regan Giesinger
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Patrick J. McNamara
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Jonathan Klein
- Division of Neonatology Stead Family Children’s Hospital University of Iowa Iowa City IA
| | - Jimmy Windsor
- Division of Pediatric Anesthesia University of Iowa Carver College of Medicine Iowa City IA
| | - Osamah Aldoss
- Division of Pediatric Cardiology Stead Family Children’s Hospital University of Iowa Iowa City IA
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Patent ductus arteriosus in preterm infants: is early transcatheter closure a paradigm shift? J Perinatol 2019; 39:1449-1461. [PMID: 31562396 DOI: 10.1038/s41372-019-0506-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Abstract
The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain owing the lack of evidence for long-term benefits and the limited analyses of the complications of medical and surgical interventions to date. In recent years, devices suitable to plug the PDA of premature infants (including extremely low birthweight, <1000 g) have become available and several trials have demonstrated successful and safe transcatheter PDA closure (TCPC) in this population. Whether TCPC represents a paradigm shift in PDA management that will result in improved short- and long-term outcomes, less bronchopulmonary dysplasia, improved neurodevelopment, or better long term renal function remains to be seen. Careful rigorous study of the potential benefits of TCPC in this highly vulnerable population in the context of well-designed adequately powered trials is needed prior to widespread adoption of this approach.
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