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Fernandez MC, Kase JS, Giamelli J, Reichlin A. Morbidity and neurodevelopmental outcomes at 2 years in preterm infants undergoing percutaneous transcatheter closure vs. surgical ligation of the PDA. J Perinatol 2024; 44:1454-1462. [PMID: 38831120 DOI: 10.1038/s41372-024-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Review a cohort of preterm infants ≤29 weeks of gestation at birth and compare morbidities and neurodevelopmental outcomes based on PDA status and type of PDA closure. STUDY DESIGN Single center observational retrospective-prospective case control study of premature infants who had no hsPDA, underwent surgical ligation or percutaneous transcatheter closure of the PDA. Neurodevelopmental testing was done using the Bayley Scales of Infant Development 3rd ed. RESULTS The percutaneous transcatheter closure group had an older post menstrual age and greater weight at the time of procedure, and started enteral feeds and achieved room air status at an earlier post procedure day. Infants in the surgical ligation group were more likely to experience vocal cord paralysis. There was no difference in neurodevelopmental outcomes between groups. CONCLUSION Waiting for infants to achieve the appropriate size for percutaneous transcatheter closure of the PDA may lead to reduced short-term complications without increasing the risk of neurodevelopmental impairment.
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Affiliation(s)
- Maria Cristina Fernandez
- Sunrise Children's Hospital, Las Vegas, NV, USA.
- The Regional Neonatal ICU Maria Fareri Children's Hospital at Westchester Medical Center - New York Medical College Valhalla, Valhalla, NY, USA.
| | - Jordan S Kase
- The Regional Neonatal ICU Maria Fareri Children's Hospital at Westchester Medical Center - New York Medical College Valhalla, Valhalla, NY, USA
| | - Joseph Giamelli
- Pediatric Cardiology Intervention, Maria Fareri Children's Hospital at Westchester Medical Center-New York Medical College Valhalla, Valhalla, NY, USA
| | - Amy Reichlin
- The Regional Neonatal ICU Maria Fareri Children's Hospital at Westchester Medical Center - New York Medical College Valhalla, Valhalla, NY, USA
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2
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Tabb C, Aggarwal S, Bajaj M, Natarajan G. Comparative Effectiveness of Surgical Ligation and Catheter Closure of Patent Ductus Arteriosus in Preterm Infants. Pediatr Cardiol 2024; 45:1515-1523. [PMID: 37316609 DOI: 10.1007/s00246-023-03199-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
To evaluate the association, if any, between closure modality (surgical ligation SL vs. catheter CC) of a hemodynamically significant patent ductus arteriosus (PDA), after failure of or contraindication to medical therapy, and immediate procedural complications, and post-procedure physiologic status in preterm (gestational age < 32 weeks) infants. In this single-center retrospective cohort study, data were accessed on infants < 32 weeks gestation, who underwent SL or CC of PDA, born from 2019-2021. The choice of modality was determined by parents, after they were provided information on both procedures. Our cohort (n = 112) included 36 (32.1%) infants who underwent SL while 76 (67.9%) underwent CC. The SL group of infants were significantly more immature at birth, younger on admission to the level IV NICU and received more mean (SD) surfactant doses than the CC group. Higher proportions of infants in the SL group had 5-min Apgar scores ≤ 5, seizures, severe intracranial hemorrhage and had received medical therapy for PDA. Both procedures were highly efficacious, with 1 unsuccessful device placement attempt and had low associated adverse events. Two (2.6%) infants had device migration 24 h after CC. SL was associated with a higher rate of immediate postoperative hypothermia whereas, in the CC group, mean airway pressure was significantly lower 48 h after, compared to before the procedure. SL and CC are comparable in short-term efficacy and safety for PDA closure. Long-term outcomes data are needed following both procedures.
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Affiliation(s)
- Carl Tabb
- Division of Neonatology, Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, PediatricsDetroit, CentralMI, USA
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Monika Bajaj
- Division of Neonatology, Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, PediatricsDetroit, CentralMI, USA
| | - Girija Natarajan
- Division of Neonatology, Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, PediatricsDetroit, CentralMI, USA.
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Levy PT, Pellicer A, Schwarz CE, Neunhoeffer F, Schuhmann MU, Breindahl M, Fumagelli M, Mintzer J, de Boode W. Near-infrared spectroscopy for perioperative assessment and neonatal interventions. Pediatr Res 2024; 96:922-932. [PMID: 34716423 DOI: 10.1038/s41390-021-01791-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022]
Abstract
Perioperative applications of near-infrared spectroscopy (NIRS) to monitor regional tissue oxygenation and perfusion in cardiac and noncardiac surgery are of increasing interest in neonatal care. Complex neonatal surgery can impair adequate oxygen delivery and tissue oxygen consumption and increase the risk of neurodevelopmental delay. Coupled with conventional techniques, NIRS monitoring may enable targeted hemodynamic management of the circulation in both cardiac and noncardiac surgical procedures. In this narrative review, we discuss the application of perioperative NIRS in specific neonatal interventions, including surgical intervention for congenital heart defects, definitive closure of the patent ductus arteriosus, neurological and gastrointestinal disorders, and use of extracorporeal membrane oxygenation. We identified areas for future research within disease-specific indications and offer a roadmap to aid in developing evidence-based targeted diagnostic and management strategies in neonates. IMPACT: There is growing recognition that perioperative NIRS monitoring, used in conjunction with conventional monitoring, may provide critical hemodynamic information that either complements clinical impressions or delivers novel physiologic insight into the neonatal circulatory and perfusion pathways.
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Affiliation(s)
- Philip T Levy
- Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Christoph E Schwarz
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
- Infant Research centre, University College Cork Ireland, Cork, Ireland
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Morten Breindahl
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Monica Fumagelli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Jonathan Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | - Willem de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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Lembo C, Méot M, Mellul K, Aryafar A, Szézépanski I, Iacobelli S, Kermorvant-Duchemin E, Bonnet D, Malekzadeh-Milani S, Lapillonne A. Renal function after ductus arteriosus transcatheter closure with or without angiography in very preterm infants. Acta Paediatr 2024; 113:955-961. [PMID: 38180109 DOI: 10.1111/apa.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
AIM Transcatheter closure of the patent ductus arteriosus (TCPDA) is increasingly used in preterm infants as an alternative to surgical ligation. However, clinically ill preterm infants are at risk of contrast nephropathy due to the angiography contrast agents used during the procedure. METHODS We performed a single-centre before-and-after comparative study in VLBW infants to compare the kinetics of serum creatinine during the first 4 days after TCPDA with or without angiography. RESULTS 69 patients were included and divided into two groups: TCPDA with (contrast+; n = 37) and without (contrast-, n = 32) use of contrast agent. The median dose [range] of contrast agent was 1.0 mL/kg [0.6-2.4 mL/kg]. The change in serum creatinine level between day 2 to 4 after TCPCA and baseline decreased in the contrast- group (-17% [-46%; 18%]), while it increased in the contrast+ group (7% [-24%; 202%] p = 0.002). Comparison of blood urea levels between groups showed similar significant differences. The change in serum creatinine between day 2 to 4 and baseline was significantly correlated with the dose of contrast agent (r2 = 0.682; p < 0.001). CONCLUSION The use of contrast agents during TCPDA can potentially harm the renal function of very preterm infants. Therefore, we advise minimising or avoiding the use of contrast agents.
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Affiliation(s)
- Chiara Lembo
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Mathilde Méot
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, APHP Hôpital Necker-Enfants Malades, Paris, France
| | - Kelly Mellul
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Annahita Aryafar
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Isabelle Szézépanski
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, APHP Hôpital Necker-Enfants Malades, Paris, France
| | - Silvia Iacobelli
- Réanimation Néonatale et Pédiatrique, Néonatologie, CHU La Réunion, Saint Pierre, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, APHP Hôpital Necker-Enfants Malades, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, APHP Hôpital Necker-Enfants Malades, Paris, France
| | - Alexandre Lapillonne
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
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Duboue PM, Padovani P, Bouteiller XP, Martin-Kabore F, Benbrik N, Gronier CG, Bouissou A, Garnier E, Mitanchez D, Flamant C, Rozé JC, Baruteau AE, Lefort B. Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study. Eur J Pediatr 2024; 183:2193-2201. [PMID: 38381375 DOI: 10.1007/s00431-024-05481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24 h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000 g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2 weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.
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MESH Headings
- Humans
- Ductus Arteriosus, Patent/surgery
- Retrospective Studies
- Infant, Newborn
- Female
- Ligation/methods
- Ligation/adverse effects
- Male
- Cardiac Catheterization/methods
- Cardiac Catheterization/adverse effects
- Infant, Premature
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Infant, Low Birth Weight
- Incidence
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/methods
- Syndrome
- Propensity Score
- Septal Occluder Device
- Risk Factors
- Infant, Premature, Diseases/surgery
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/therapy
- Infant, Premature, Diseases/epidemiology
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Affiliation(s)
| | - Paul Padovani
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Xavier Paul Bouteiller
- Department of Cardiology, Electrophysiology and Heart Modelling Institute, CHU Bordeaux, IHU Liryc, Bordeaux University Foundation, Pessac, France
| | | | - Nadir Benbrik
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Céline Grunenwald Gronier
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
| | - Antoine Bouissou
- Department of Neonatology, CHU Tours, Tours University, Tours, France
| | - Elodie Garnier
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France
| | - Delphine Mitanchez
- Department of Neonatology, CHU Tours, Tours University, Tours, France
- INSERM UMR_S 938 Centre de Recherche Saint Antoine, Paris, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes University, Nantes, France
| | | | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, CHU Nantes, Nantes University, Nantes, France
- INSERM, CIC FEA 1413, Nantes University, Nantes, France
- CNRS, INSERM, L'institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Bruno Lefort
- Institut Des Cardiopathies Congénitales de Tours, FHU PreciCare, CHU Tours, Tours University, Tours, France.
- UMR 1069, INSERM, Tours University, Tours, France.
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Clocheville Hospital, CHRU Tours, 49, Boulevard Béranger, 37000, Tours, France.
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Melchior CDS, Neves GR, de Oliveira BL, Toguchi AC, Lopes JC, Pavione MA, Enríquez SKT. Percutaneous closure of patent ductus arteriosus versus surgical treatment in low-birth-weight preterms: a systematic review and meta-analysis. Cardiol Young 2024; 34:705-712. [PMID: 38329109 DOI: 10.1017/s1047951123004353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION The optimal management of a patent ductus arteriosus in a population of preterm infants is controversial. Traditionally, when the patent ductus arteriosus does not close either with conservative treatment or in response to pharmacological therapy, the only option is surgical closure. However, transcatheter occlusion might provide a therapeutic alternative. METHODS We searched PubMed, Embase, and Cochrane databases for non-randomised and randomised controlled trials that compared transcatheter percutaneous closure of patent ductus arteriosus with surgical ligation in low-birth-weight preterm infants (<2,500 g). A random-effects model was used for outcomes with high heterogeneity. RESULTS We included twelve studies comprising 4,668 low-birth-weight preterm infants, of whom 966 (20.7%) were in the transcatheter percutaneous closure group, and 3,702 (79.3%) patients were included in the surgical group. All-cause mortality (OR 0.28; 95% confidence interval 0.18-0.423; p < 0.00001; I2 = 0%) and haemodynamic instability (OR 0.10; 95% confidence interval 0.05-0.21; p < 0.001; I2 = 14%) were significantly lower in the transcatheter percutaneous closure group. There was no significant difference between transcatheter and surgical patent ductus arteriosus closure for the outcomes of bronchopulmonary dysplasia (0.93; 95% confidence interval 0.46-1.87; p = 0.83; I2 = 0%) and major complications (OR 0.76; 95% confidence interval 0.34-1.69; p = 0.51; I2 = 43%). CONCLUSION These findings suggest that transcatheter patent ductus arteriosus closure in preterm infants under 2,500 g is a safe and effective alternative to surgical treatment. There was a substantial reduction in all-cause mortality and haemodynamic instability with transcatheter intervention compared to surgical closure.
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Kikuchi N, Goto T, Katsumata N, Murakami Y, Shinohara T, Maebayashi Y, Sakakibara A, Saito C, Hasebe Y, Hoshiai M, Nemoto A, Naito A. Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome. J Cardiovasc Dev Dis 2024; 11:26. [PMID: 38248896 PMCID: PMC10816731 DOI: 10.3390/jcdd11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
In patent ductus arteriosus (PDA) in preterm infants, the relationship between treatment timing and long-term developmental prognosis remains unclear. The purpose of this study was to clarify the relationship between the age in days when ductus arteriosus closure occurred and long-term development. Preterm infants with a birth weight of less than 1500 g who were admitted to our NICU over a period of 9 years (2011-2019) and were diagnosed with PDA were included. A new version of the K-type developmental test for corrected ages of 1.5 and 3 years was used as an index of development. The relationship between the duration of PDA and the developmental index was evaluated using Pearson's correlation coefficient, and multiple regression analysis was performed. Development quotient (DQ) at the ages of 1.5 and 3 years showed a correlation with the PDA closure date and the standard deviation (SD) value of the term birth weight. Multiple regression analysis showed a positive correlation of the DQ at 1.5 and 3 years with the SD value of the term birth weight and a negative correlation with the PDA closure date. In addition, a stronger correlation was found in the "posture/motor" sub-item at 3 years. On the other hand, the analysis including preterm infants without PDA showed that preterm infants with PDA closure on the 6th day or later after birth had a significantly lower 3-year-old DQ than preterm infants with a PDA exposure within 5 days. In conclusion, it is suggested that the decrease in cerebral blood flow due to PDA in preterm infants has an adverse effect on long-term neurodevelopment. Appropriate interventions, including surgical treatment for PDA in preterm infants without delay, ideally within 5 days of birth, may be effective in improving the developmental prognosis.
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Affiliation(s)
- Natsumi Kikuchi
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
- Department of Pediatrics, School of Medicine, Yamanashi University, Kofu 409-3821, Japan;
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan
| | - Nobuyuki Katsumata
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Yasushi Murakami
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Tamao Shinohara
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Yuki Maebayashi
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Aiko Sakakibara
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Chisato Saito
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Yohei Hasebe
- Department of Pediatrics, School of Medicine, Yamanashi University, Kofu 409-3821, Japan;
| | - Minako Hoshiai
- Cardiovascular Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan;
| | - Atsushi Nemoto
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
| | - Atsushi Naito
- Department of Neonatology, Perinatal Center, Yamanashi Prefectural Central Hospital, Kofu 400-8506, Japan; (N.K.); (N.K.); (Y.M.); (T.S.); (Y.M.); (A.S.); (C.S.); (A.N.); (A.N.)
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Honnorat M, Perouse-De-Montclos T, Bakloul M, Walton C, Butin M, Vo Van P. Transcatheter closure of patent ductus arteriosus in preterm infants: results from a single-center cohort. Front Pediatr 2023; 11:1292623. [PMID: 38178913 PMCID: PMC10765538 DOI: 10.3389/fped.2023.1292623] [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: 09/11/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To assess the success rate of patent ductus arteriosus (PDA) transcatheter closure in preterm infants and to describe the nature of procedural adverse events and short-term clinical status. Study design All the preterm infants with PDA transcatheter closure were evaluated retrospectively between July 2019 and March 2023 in a single level III neonatal intensive care unit in France. The procedure was performed in the catheterization laboratory using venous canulation. We retrospectively collected data about the patients' characteristics, procedural outcomes and complications. Results Twenty-five infants born between 23.4 and 32.0 weeks of gestational age (mean ± SD 26.3 ± 1.9 weeks) underwent transcatheter PDA closure. Their mean age and weight at the time of the procedure were 52 days (range 22-146 days) and 1,620 g (range 890-3,700 g), respectively. Successful closure was achieved in all but one patient. Procedure related complications were reported in 10 infants (40%), including 6 left pulmonary artery stenosis one of which required a balloon dilatation, two cardiac tamponades and two inferior vena cava thrombosis. Only two post-ligature syndromes occurred after the procedure. Two infants died one of which was related to the procedure. Conclusion Transcatheter closure of a PDA is a valid alternative to surgical ligation due to its high success rate and low incidence of post-ligature syndrome. Nevertheless, we also report rare, although serious complications.
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Affiliation(s)
- Marion Honnorat
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
| | | | - Mohamed Bakloul
- Service de Cardiologie Pédiatrique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Camille Walton
- Cardiologie pédiatrique, Hôpital Privé Natécia, Lyon, France
| | - Marine Butin
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
- INSERM U1111, CNRS UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Equipe “Pathogénie des Infections à Staphylocoques”, Lyon, France
| | - Philippe Vo Van
- Service de Réanimation Néonatale, HFME, Hospices Civils de Lyon, Bron, France
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9
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Baruteau AE, Fraisse A, Butera G, Bautista-Rodriguez C. The Transcatheter Closure of Patent Ductus Arteriosus in Extremely Low-Birth-Weight Infants: Technique and Results. J Cardiovasc Dev Dis 2023; 10:476. [PMID: 38132644 PMCID: PMC10744056 DOI: 10.3390/jcdd10120476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered as first-line therapy, although it carries a limited success rate and potential severe adverse events. In recent years, transcatheter patent ductus arteriosus closure has fast developed and become widely accepted as a safe and efficient alternative to surgical ductal ligation in extremely low birth weight infants >700 g, using most often the dedicated Amplatzer Piccolo Occluder device. This article aims to provide an appraisal of the patients' selection process, and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, CHU Nantes, Nantes Université, FHU PRECICARE, F-44000 Nantes, France
- CIC FEA 1413, INSERM, CHU Nantes, Nantes Université, F-44000 Nantes, France
- L’institut du thorax, INSERM, CNRS, CHU Nantes, Nantes Université, F-44000 Nantes, France
- UMR 1280, PhAN, INRAE, Nantes Université, F-44000 Nantes, France
| | - Alain Fraisse
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carles Bautista-Rodriguez
- Pediatric Cardiology Services, Royal Brompton Hospital, Guy’s & St Thomas’ Foundation Trust, London SW3 6NP, UK; (A.F.); (C.B.-R.)
- National Heart and Lung Institute, Imperial College, London SW7 2BX, UK
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10
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Meliota G, Vairo U. Transcatheter Interventions for Neonates with Congenital Heart Disease: A Review. Diagnostics (Basel) 2023; 13:2673. [PMID: 37627932 PMCID: PMC10453781 DOI: 10.3390/diagnostics13162673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/28/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Newborns with congenital heart disease often require interventions linked to high morbidity and mortality rates. In the last few decades, many transcatheter interventions have become the first-line treatments for some critical conditions in the neonatal period. A catheter-based approach provides several advantages in terms of procedural time, length of hospitalization, repeatability and neurodevelopmental issues (usually related to cardiopulmonary bypass). The main transcatheter procedures will be reviewed, as they are now valid alternatives to conventional surgical management.
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Affiliation(s)
- Giovanni Meliota
- Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy;
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11
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Bischoff AR, Stanford AH, Aldoss O, Rios DR, McLennan DI, Mohammad Nijres B, Giesinger RE, McNamara PJ. Left ventricular function before and after percutaneous patent ductus arteriosus closure in preterm infants. Pediatr Res 2022:10.1038/s41390-022-02372-6. [PMID: 36380071 DOI: 10.1038/s41390-022-02372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Definitive closure of the patent ductus arteriosus (PDA) is associated with significant changes in the loading conditions of the left ventricle (LV), which may lead to cardiovascular and respiratory instability. The objective of the study was to evaluate targeted neonatal echocardiography (TnECHO) characteristics and the clinical course of preterm infants ≤2 kg undergoing percutaneous PDA closure. METHODS Retrospective cohort study of prospectively acquired pre- and post-closure TnECHOs to assess hemodynamic changes. Cardiorespiratory parameters in the first 24 h following PDA closure were also evaluated. RESULTS Fifty patients were included with a mean age of 30.6 ± 9.6 days and weight of 1188 ± 280 g. LV global longitudinal strain decreased from -20.6 ± 2.6 to -14.9 ± 2.9% (p < 0.001) after 1 h. There was a decrease in LV volume loading, left ventricular output, LV systolic and diastolic parameters. Cardiorespiratory instability occurred in 24 (48%) [oxygenation failure in 44%] but systolic hypotension and/or need for cardiovascular medications was only seen in 6 (12%). Patients with instability had worse baseline respiratory severity score and lower post-closure early diastolic strain rates. CONCLUSIONS Percutaneous PDA closure leads to a reduction in echocardiography markers of LV systolic/diastolic function. Post-closure cardiorespiratory instability is characterized primarily by oxygenation failure and may relate to impaired diastolic performance. IMPACT Percutaneous patent ductus arteriosus closure leads to a reduction in echocardiography markers of left ventricular volume loading, cardiac output, and left ventricular systolic/diastolic function. Post-procedural cardiorespiratory instability is characterized primarily by oxygenation failure. Post-procedural cardiorespiratory instability may relate to impaired diastolic performance.
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Affiliation(s)
| | - Amy H Stanford
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Osamah Aldoss
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Danielle R Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Daniel I McLennan
- Section of Pediatric Cardiology, The Herma Heart Institute, Milwaukee, WI, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bassel Mohammad Nijres
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Regan E Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA. .,Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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12
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Herron C, Forbes TJ, Kobayashi D. Renal Function After Transcatheter Piccolo Patent Ductus Arteriosus Closure With Contrast Angiography in Extremely Premature Infants. Am J Cardiol 2022; 181:113-117. [PMID: 35970628 DOI: 10.1016/j.amjcard.2022.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022]
Abstract
Transcatheter patent ductus arteriosus (PDA) device closure is increasingly performed in extremely premature infants. Contrast angiography improves the procedural safety and effectiveness by precise anatomic delineation. Contrast nephropathy is a concern in clinically ill premature infants, especially with the presence of renal insufficiency. We hypothesized that the benefit of transcatheter PDA closure outweighs the harm of contrast nephropathy in extremely premature infants. A total of 160 infants underwent successful transcatheter (n = 59) and surgical (n = 101) PDA closure at a median age of 26 (7 to 78) days. The surgical group had a lower procedural weight (870 vs 960 g, p = 0.014). In the transcatheter group, serum creatinine decreased from 0.48 to 0.45 mg/100 ml at 24 hours (p = 0.003, n = 59) and decreased further to 0.37 mg/100 ml at 5 to 7 days after closure (p <0.001). Median contrast amount was 1.9 ml/kg (0.6 to 6.1). In 8 infants with pre-existing renal insufficiency who underwent transcatheter closure, serum creatine significantly improved from 1.44 to 1.36 mg/100 ml at 24 hours and 0.79 mg/100 ml at 5 to 7 days after closure (p <0.001). There was no difference in improvement of serum creatinine between transcatheter and surgical closure groups. In conclusion, despite the use of contrast, serum creatinine significantly improved with transcatheter PDA closure even in infants with pre-existing renal insufficiency. Contrast angiography should not be discouraged for transcatheter PDA closure because of the concern for contrast nephropathy in extremely premature infants.
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Affiliation(s)
- Christopher Herron
- Division of Cardiology, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Thomas J Forbes
- Division of Cardiology, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Daisuke Kobayashi
- Division of Cardiology, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan.
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13
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Phenotyping respiratory decompensation following definitive closure of the patent ductus arteriosus in preterm infants. J Perinatol 2022; 42:649-654. [PMID: 34650199 DOI: 10.1038/s41372-021-01226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/27/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify risk factors associated with high-frequency ventilation (HFV) following definitive closure of the patent ductus arteriosus (PDA). METHODS We performed a retrospective study of premature infants (<37 weeks) who were mechanically ventilated before and after surgical or transcatheter PDA closure. Primary outcome was HFV requirement within 24 h of procedure. Logistic regression was used to estimate clinical associations with post procedure HFV requirement. RESULTS We identified 110 infants who were mechanically ventilated before PDA closure, of which 48 (44%) escalated to HFV within 24 h after closure. In the multivariable model, surgical ligation (OR 21.5, 95% CI 1.6-284), elevated Respiratory Severity Score (RSS) 1 h post-procedure (OR 1.78, 95% CI 1.07-2.99) and 12 h post-procedure (OR 2.12, 95% CI 1.37-3.26) were independent predictors of HFV. CONCLUSION Surgical ligation and elevated RSS values over the first 12 h after PDA closure are risk factors for HFV.
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14
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Pandey R, Youmans L, Aneji C, Bell C, Breinholt J, Khan A. Extremely premature infants with patent ductus arteriosus closure: Comparative analysis of surgical ligation versus cardiac catheterization-based closure. Medicine (Baltimore) 2022; 101:e29103. [PMID: 35357352 PMCID: PMC11319327 DOI: 10.1097/md.0000000000029103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/26/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Our objective was to compare postprocedure hemodynamic decompensation in extremely premature infants who had their patent ductus arteriosus (PDA) closed with surgical ligation (SL) versus cardiac catheter-based closure (CCC).This is a single-center retrospective review of extremely premature ( < 28 weeks) infants who had their PDA closed by SL or CCC.Of the total of 69 infants, 53 underwent SL, and 16 had CCC. Infants in 2 groups were comparable at birth. However, at the time of the procedure, infants in the SL group were smaller, less mature, and had higher respiratory support. Vasopressor use, both pre- and postprocedure, was more common in the SL group. Nineteen percent of the infants in the SL group, compared to 6% in the CCC group (P = .34), required dose escalation or use of vasopressors after the PDA closure.There was no significant difference between the 2 groups in postoperative hemodynamic decompensation. Large, multicenter, prospective study or randomized control trial will help to confirm our findings.
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Affiliation(s)
- Rajesh Pandey
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX,
| | - Lydia Youmans
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX,
| | - Chiamaka Aneji
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX,
| | - Cynthia Bell
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX,
| | | | - Amir Khan
- McGovern School of Medicine, University of Texas, Health Science Center at Houston, Houston, TX,
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15
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Barcroft M, McKee C, Berman DP, Taylor RA, Rivera BK, Slaughter JL, El-Khuffash A, Backes CH, Backes CH. Percutaneous Closure of Patent Ductus Arteriosus. Clin Perinatol 2022; 49:149-166. [PMID: 35209997 PMCID: PMC8887783 DOI: 10.1016/j.clp.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneous-based patent ductus arteriosus closure is technically feasible among infants less than 1.5 kg. However, marked heterogeneity in the type and nature of adverse events obscures current safety profile assessments. Although data on the risks of postdevice closure syndrome remain promising, a lack of comparative trials of surgical ductal ligation and inconsistent surveillance across published studies obscure confidence in present estimates of safety and efficacy. To minimize risk and yield the greatest benefits, clinical studies of patent ductus arteriosus treatment should consider incorporating more robust assessments to ensure that infants at greatest risk for adverse ductal consequences are included.
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Affiliation(s)
- Megan Barcroft
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christopher McKee
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Anesthesiology, Nationwide Children’s Hospital, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Darren P. Berman
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Rachel A. Taylor
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
| | - Brian K. Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Jonathan L. Slaughter
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital; Dublin, Ireland,Department of Paediatrics; The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carl H. Backes
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH,The Heart Center, Nationwide Children’s Hospital, Columbus, OH,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
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16
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Kuntz MT, Staffa SJ, Graham D, Faraoni D, Levy P, DiNardo J, Maschietto N, Nasr VG. Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children's Hospitals. J Am Heart Assoc 2021; 11:e022776. [PMID: 34970919 PMCID: PMC9075185 DOI: 10.1161/jaha.121.022776] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharmacologic therapy for patent ductus arteriosus closure is not consistently successful. Surgical ligation (SL) or transcatheter closure (TC) may be needed. Large multicenter analyses comparing outcomes and resource use between SL and TC are lacking. We hypothesized that patients undergoing TC have improved outcomes compared with SL, including mortality, hospital and intensive care unit length of stay, and mechanical ventilation. Methods and Results Using the 2016 to 2020 Pediatric Health Information System database, characteristics, outcomes, and charges of patients aged <1 year who underwent TC or SL were analyzed. A total of 678 inpatients undergoing TC (n=503) or SL (n=175) were identified. Surgical patients were younger (0.1 versus 0.53 years; P<0.001) and more premature (60% versus 20.3%; P<0.001). Surgical patients had higher mortality (1.7% versus 0%; P=0.02). Using inverse probability of treatment weighting by the propensity score, multivariable-adjusted analyses demonstrated favorable outcomes in TC: intensive care unit admission rates (adjusted odds ratio [OR], 0.2; 95% CI, 0.11-0.32; P<0.001); mechanical ventilation rates (adjusted OR, 0.3; 95% CI, 0.19-0.56; P<0.001); and shorter hospital (adjusted coefficient, 2 days shorter; 95% CI, 1.3-2.7; P<0.001) and postoperative (adjusted coefficient, 1.2 days shorter; 95% CI, 0.1-2.3; P=0.039) stays. Overall charges and readmission rates were similar. Among premature neonates and infants, hospital (adjusted difference in medians, 4 days; 95% CI, 1.7-6.3 days; P<0.001) and postoperative stays (adjusted difference in medians, 3 days; 95% CI, 1.1-4.9 days; P=0.002) were longer for SL. Conclusions TC is associated with lower mortality and reduced length of stay compared with SL. Rates of TC continue to increase compared with SL.
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Affiliation(s)
- Michael T Kuntz
- Department of Anesthesiology Critical Care and Pain Medicine Boston Children's HospitalHarvard Medical School Boston MA.,Division of Pediatric Cardiac Anesthesiology Department of Anesthesiology Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville TN
| | - Steven J Staffa
- Department of Anesthesiology Critical Care and Pain Medicine Boston Children's HospitalHarvard Medical School Boston MA
| | - Dionne Graham
- Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston MA
| | - David Faraoni
- Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia Department of Anesthesiology, Perioperative and Pain Medicine Texas Children's HospitalBaylor College of Medicine Houston TX
| | - Philip Levy
- Division of Newborn Medicine Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston MA
| | - James DiNardo
- Department of Anesthesiology Critical Care and Pain Medicine Boston Children's HospitalHarvard Medical School Boston MA
| | - Nicola Maschietto
- Department of Cardiology Boston Children's HospitalHarvard Medical School Boston MA
| | - Viviane G Nasr
- Department of Anesthesiology Critical Care and Pain Medicine Boston Children's HospitalHarvard Medical School Boston MA
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17
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Scerbo D, Cua CL, Rivera BK, Marzec LC, Smith CV, Slaughter JL, Berman DP, Backes CH. Percutaneous Closure of the Patent Ductus Arteriosus in Very-Low-Weight Infants. Neoreviews 2021; 21:e469-e478. [PMID: 32611564 DOI: 10.1542/neo.21-7-e469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In view of the known complications of drug therapy and open surgical ligation, and the potential for prolonged patent ductus arteriosus (PDA) exposure to be harmful, health care practitioners have sought new approaches to achieve definitive ductal closure. Interest in percutaneous (catheter-based) PDA closure has emerged within the neonatal community as a viable treatment option, because it has been fueled by recent procedural and device modifications, as well as mounting feasibility and safety data. Herein, we provide a contemporary review of percutaneous PDA closure among infants at the crux of the medical debate-very-low-weight infants (≤1,500 g), including: 1) characterization of traditional PDA treatments (drug therapy, open surgical ligation) and conservative (nonintervention) management options; 2) a general overview of the major procedural steps of percutaneous ductal closure, including efforts to reduce thrombotic complications and the emergence of a novel US Food and Drug Administration-approved device; 3) a systematic review and meta-analysis to better understand risk profiles of percutaneous PDA closure in this population; and 4) discussion of current gaps in our understanding of optimal PDA care, including the critical need for well-designed, randomized, controlled clinical trials.
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Affiliation(s)
- Danielle Scerbo
- The Ohio University Heritage College of Osteopathic Medicine, Athens, OH.,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Clifford L Cua
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Brian K Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Laura C Marzec
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, WA
| | - Jonathan L Slaughter
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH
| | - Darren P Berman
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Carl H Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,The Heart Center, Nationwide Children's Hospital, Columbus, OH.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH
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18
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Respiratory Trajectory after Invasive Interventions for Patent Ductus Arteriosus of Preterm Infants. CHILDREN-BASEL 2021; 8:children8050398. [PMID: 34063345 PMCID: PMC8156843 DOI: 10.3390/children8050398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, neonatal morbidities, periprocedural vital signs, and respiratory support trajectories were compared between the transcatheter-treated and surgically ligated group. A total of 31 eligible VLBW infants received invasive intervention: 14 were treated with transcatheter occlusion (Group A), and 17 infants were treated with surgical ligation (Group B). Respiratory outcomes were not statistically significant between the two groups, despite Group A showing a trend toward early improvement in post-intervention respiratory trajectory. In this small case study, a different trend in post-intervention respiratory trajectories was observed. Future research with larger case numbers should be conducted to address our preliminary observations in more detail.
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19
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Parkerson S, Philip R, Talati A, Sathanandam S. Management of Patent Ductus Arteriosus in Premature Infants in 2020. Front Pediatr 2021; 8:590578. [PMID: 33643964 PMCID: PMC7904697 DOI: 10.3389/fped.2020.590578] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the topic, the decision to treat the PDA is still strongly debated among cardiologists, surgeons, and neonatologists. This is in part due to the shortage of long-term benefits with the interventions studied. Practice variations still exist within sub-specialties and centers. This article briefly summarizes the history, embryology and histology of the PDA. It also succinctly discusses the hemodynamic significance of a PDA which builds the framework to review all the available literature on PDA closure in premature infants, though not a paradigm shift just yet; it introduces transcatheter PDA closure (TCPC) as a possible armament to the clinician for this age-old problem.
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Affiliation(s)
- Sarah Parkerson
- Department of Pediatrics, University of Tennessee, Memphis, TN, United States
| | - Ranjit Philip
- Division of Pediatric Cardiology, University of Tennessee, Memphis, TN, United States
| | - Ajay Talati
- Division of Neonatology, University of Tennessee, Memphis, TN, United States
| | - Shyam Sathanandam
- Division of Pediatric Cardiology, University of Tennessee, Memphis, TN, United States
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20
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Bischoff AR, Giesinger RE, Bell EF, McNamara PJ. Precision medicine in neonatal hemodynamics: need for prioritization of mechanism of illness and defining population of interest. J Perinatol 2020; 40:1446-1449. [PMID: 32719495 DOI: 10.1038/s41372-020-0741-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Adrianne Rahde Bischoff
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Regan E Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Edward F Bell
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
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21
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Shu Y, Guo Y, Wang X, Zhou D. Short-term results of interventional therapy for infants (7-36 months old) with patent ductus arteriosus and moderate-to-severe pulmonary hypertension: a retrospective study. J Cardiothorac Surg 2020; 15:68. [PMID: 32321548 PMCID: PMC7178739 DOI: 10.1186/s13019-020-01110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/13/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a common congenital heart disease. Interventional therapy is an important treatment for PDA. Nevertheless, few studies have investigated the safety and effectiveness of interventional therapy for infants (age, 0-36 months) with PDA and moderate-to-severe pulmonary hypertension. Therefore, this study aimed to analyze the short-term (6 months) results and interventional therapy experience for infants with PDA and moderate-to-severe pulmonary hypertension. METHODS Clinical records, echocardiographic data, and angiocardiography data of 28 infants (age, 7-36 months) who underwent interventional therapy for PDA and moderate-to-severe pulmonary hypertension between December 2011 and January 2017 at our hospital were retrospectively analyzed. All infants were treated using an Amplatzer occluder with local and deep sedation anesthesia under radiographic guidance. RESULTS Infants with PDA and moderate-to-severe pulmonary hypertension had poor growth. Trace residual shunts were found in two infants immediately after procedure; both had disappeared by 6 months after procedure. No significant interventional therapy-related complications occurred in the other cases. Pulmonary systolic pressure, left atrial dimension, and left ventricular end-diastolic dimension immediately after interventional therapy and 6 months later were lower than the preoperative levels (P < 0.05). The left atrial and left ventricular end-diastolic dimensions at 6 months after interventional therapy were smaller than those immediately after interventional therapy (P < 0.05). Pulmonary systolic pressure rates immediately after interventional therapy and 6 months later were not significantly different (P = 0.505). Moreover, there were no significant differences in the left ventricular ejection fraction before, immediately after, and at 6 months after interventional therapy (P = 0.628). CONCLUSIONS For infants (age, 7-36 months) with PDA and moderate-to-severe pulmonary hypertension, interventional therapy can achieve excellent immediate and short-term (6 months) results with careful preoperative evaluations, strict operative procedures, and careful follow-up.
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Affiliation(s)
- Yue Shu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, People's Republic of China, 570311
| | - Yilong Guo
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, People's Republic of China, 570311
| | - Xiaoqi Wang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, People's Republic of China, 570311.
| | - Dexing Zhou
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, People's Republic of China, 570311
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Martini S, Aceti A, Galletti S, Beghetti I, Faldella G, Corvaglia L. To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus. Nutrients 2019; 12:nu12010083. [PMID: 31892190 PMCID: PMC7019993 DOI: 10.3390/nu12010083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 12/20/2022] Open
Abstract
The management of enteral feeds in preterm infants with a hemodynamically significant patent ductus arteriosus (hs-PDA) is a major challenge for neonatologists due to the fear of gastrointestinal (GI) complications. This review aims to analyze the available evidence on the complex relation between the presence and management of PDA, enteral feeding practices, and GI outcomes in the preterm population. There is limited evidence, based on small and heterogeneous trials, that hs-PDA may affect the splanchnic hemodynamic response to enteral feeds. While the presence of PDA seems a risk factor for adverse GI outcomes, the benefits of feeding withholding during pharmacological PDA treatment are controversial. The lack of robust evidence in support of or against a timely feeding introduction or feeding withholding during pharmacological PDA closure in preterm neonates does not allow to draw any related recommendation. While waiting for further data, the feeding management of this population should be carefully evaluated and possibly individualized on the basis of the infants’ hemodynamic and clinical characteristics. Large, multicentric trials would help to better clarify the physiological mechanisms underlying the development of gut hypoperfusion, and to evaluate the impact of enteral feeds on splanchnic hemodynamics in relation to PDA features and treatment.
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