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Hoffmann JK, Khazal Z, Apers W, Sharma P, Weismann CG, Kaganov K, Wheeler CR, Farias M, Porras D, Levy P, Morton SU. Who Still Gets Ligated? Reasons for Persistence of Surgical Ligation of the Patent Ductus Arteriosus Following Availability of Transcatheter Device Occlusion for Premature Neonates. J Cardiovasc Dev Dis 2024; 11:132. [PMID: 38786954 PMCID: PMC11122133 DOI: 10.3390/jcdd11050132] [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: 03/11/2024] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: To identify reasons for the persistence of surgical ligation of the patent ductus arteriosus (PDA) in premature infants after the 2019 Food and Drug Administration (FDA) approval of transcatheter device closure; (2) Methods: We performed a 10-year (2014-2023) single-institution retrospective study of premature infants (<37 weeks) and compared clinical characteristics and neonatal morbidities between neonates that underwent surgical ligation before (epoch 1) and after (epoch 2) FDA approval of transcatheter closure; (3) Results: We identified 120 premature infants that underwent surgical ligation (n = 94 before, n = 26 after FDA approval). Unfavorable PDA morphology, active infection, and recent abdominal pathology were the most common reasons for surgical ligation over device occlusion in epoch 2. There were no differences in demographics, age at closure, or outcomes between infants who received surgical ligation in the two epochs; (4) Conclusions: Despite increasing trends for transcatheter PDA closure in premature infants, surgical ligation persists due to unfavorable ductal morphology, active infection, or abdominal pathology.
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Affiliation(s)
- Julia K. Hoffmann
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA (P.L.)
| | - Zahra Khazal
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA (P.L.)
| | - Wievineke Apers
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA (P.L.)
| | - Puneet Sharma
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA (P.L.)
| | - Constance G. Weismann
- Department of Pediatric Cardiology, Skåne University Hospital, Department of Clinical Sciences, Lund University, 221 00 Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University, 80539 Munich, Germany
| | - Kira Kaganov
- Department of Neonatology, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Craig R. Wheeler
- Departments of Respiratory Care and Extracorporeal Membrane Oxygenation, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Michael Farias
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Diego Porras
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Philip Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA (P.L.)
| | - Sarah U. Morton
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA (P.L.)
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Surak A, Sidhu A, Ting JY. Should we "eliminate" PDA shunt in preterm infants? A narrative review. Front Pediatr 2024; 12:1257694. [PMID: 38379909 PMCID: PMC10876852 DOI: 10.3389/fped.2024.1257694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
The patent ductus arteriosus frequently poses a significant morbidity in preterm infants, subjecting their immature pulmonary vascular bed to substantial volume overload. This, in turn, results in concurrent hypoperfusion to post-ductal organs, and subsequently alters cerebral blood flow. In addition, treatment has not demonstrated definitive improvements in patient outcomes. Currently, the optimal approach remains a subject of considerable debate with ongoing research controversy regarding the best approach. This article provides a comprehensive review of existing literature.
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Affiliation(s)
- Aimann Surak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Amneet Sidhu
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Joseph Y. Ting
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Aw TC, Chan B, Singh Y. Transport and Anaesthesia Consideration for Transcatheter Patent Ductus Arteriosus Closure in Premature Infants. J Cardiovasc Dev Dis 2023; 10:377. [PMID: 37754806 PMCID: PMC10531776 DOI: 10.3390/jcdd10090377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/05/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications.
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Affiliation(s)
- Tuan Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, London SW3 6NP, UK
| | - Belinda Chan
- Neonatology Division, Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA;
- Department of Radiology and Imaging Science, University of Utah, Salt Lake City, UT 84108, USA
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA;
- Department of Pediatrics, Division of Neonatology, University of Southern California (USC), Los Angeles, CA 92354, USA
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