Author + information
- Erin Nealon,
- Corey Stiver,
- Clifford Cua,
- Claire Mitchell,
- Brian Boe,
- Aimee Armstrong,
- Darren Berman,
- Charles Smith,
- Joanne Chisolm,
- Brian Rivera and
- Carl Backes
Procedural complications and short-term outcomes following transcatheter PDA (TC-PDA) occlusion in lower weight infants (LWI; <6kg) are well-described, but longer-term outcomes have not been characterized adequately. This study was to describe longer-term outcomes of LWI undergoing TC-PDA occlusion.
Retrospective study (1/03-1/16) of LWI having undergone isolated, successful (leaving the catheterization suite with a device), TC-PDA occlusion at a large, pediatric center. Echocardiograms (echos) were independently reviewed for: 1) left pulmonary artery (LPA) obstruction (mild,>2 -3 m/s; moderate,>3-4 m/s; severe,>4 m/s); 2) aortic (Ao) obstruction (peak instantaneous gradient >15 mm Hg); 3) post ligation syndrome (PLS), defined as diminished left ventricular ejection fraction (LVEF) associated with need for vasopressor support. Patient records were reviewed for adverse events (AEs) attributable to the procedure, including embolization, high velocity residual shunting requiring intervention, vascular injury, and death.
Of 107 LWI referred for TC-PDA closure, 96 underwent successful closure. Median (range) weight at the time of procedure were 3.7 (1.4-5.9) kg. We reviewed 864 echos (5 ±4 echos/patient). At least mild LPA stenosis or Ao obstruction was observed on initial and discharge echos in 24 and 13 infants, respectively. Subsequent outpatient echos revealed persistent mild LPA or Ao obstruction in 9 infants. No infants showed moderate or severe LPA obstruction post-discharge or have undergone intervention for device-related obstruction. Following closure, mean LVEF decreased (pre-procedure, 71% vs. post-procedure, 64%; p = 0.02), but returned to baseline at discharge (70%). We observed no evidence of PLS. Over a median follow-up of 28 months, AEs were observed in 5 infants: 1 embolization requiring surgical retrieval, 1 persistent residual ductal shunt requiring surgical closure, and 3 vascular injuries requiring anti-thrombotic medication. We observed 5 deaths, none attributable to the procedure.
TC-PDA occlusion among LWI appears to be generally safe. Clinical trials are needed to compare TC-PDA with surgical ligation.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: Fetal Cardiology and the Patent Ductus Arteriosus
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1124-372
- 2018 American College of Cardiology Foundation