Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications

Abstract

Background: Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg.

Methods and results: Retrospective analysis (January 2005-January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2-3.9 kg) underwent attempted PDA closure. Twenty-five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01).

Conclusions: Among infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies.

Keywords: arterial thrombosis; catheterization; complications; ductus arteriosus, patent; neonatal; pediatrics.

Figure 1

Angiographic still frames in lateral projection illustrating percutaneous closure of PDA in a premature infant. A, Type C PDA in a 1.6‐kg infant. White arrows outline length of the PDA. B, Angiographic parameters used to define PDA classification and guide closure; A, aortic ampulla; B, narrowest dimension; C, PDA size at insertion into pulmonary artery; D, PDA length. C, Aortic angiogram following deployment of a 6‐mm AVP‐II plug. PDA indicates patent ductus arteriosus.

Figure 2

A, Pulmonary Score pre‐ and post–cardiac catheterization. X‐axis represents time (days), with negative values denoting days prior to catheterization. Y‐axis designates Pulmonary Scores (mean±SD) compared to precatheterization trends; Pulmonary Scores decreased following PDA closure (linear mixed‐effect model, P<0.01). B, Proportion of neonates on mechanical ventilation pre‐ and postcatheterization. X‐axis represents time (days), with negative values denoting days prior to catheterization. Y‐axis designates proportion (%) of neonates on mechanical ventilation. Compared to precatheterization trends, the likelihood to receive mechanical ventilation following PDA closure decreased (mixed‐effects logistic model, P<0.01). PDA indicates patent ductus arteriosus.