AI Article Synopsis
- The study aimed to evaluate the safety and feasibility of percutaneous closure of patent ductus arteriosus (PDA) in neonates weighing 2 kg or less.
- It analyzed data from the IMPACT Registry and found a 3% technical failure rate and a 5.5% rate of major adverse events, with embolization and unplanned surgeries being the most common issues.
- The results suggest that as hospital experience with PDA closures increases, the risk of complications decreases, indicating that percutaneous closure in these small infants is a safe and improving practice.
Article Abstract
Objectives: Percutaneous patent ductus arteriosus (PDA) closure is becoming the standard of care for definitive closure in progressively smaller and younger neonates. The objective of this study was to assess safety and feasibility of percutaneous PDA closure in patients ≤2 kg.
Methods: This was a cohort study using the IMPACT Registry (Improving Pediatric and Adult Congenital Treatments) from the American College of Cardiology Foundation's National Cardiovascular Data Registry. Patients who were ≤2 kg at the time of percutaneous PDA closure were included. The primary outcome was the composite of technical failure and/or major adverse event.
Results: A total of 1587 attempted PDA closures were included, with a 3% incidence of technical failure and 5.5% incidence of the composite outcome. Major adverse events were observed in 3.8% of the patients; the most common events were device embolization requiring retrieval and unplanned cardiac or vascular surgery in 1.3% and 1.3% of cases, respectively. The incidence of the composite outcome was associated with the need for arterial access (P < .001) as well as annual hospital volume of percutaneous PDA closures in infants ≤2 kg (P = .001). The incidence of the composite outcome has decreased overtime, whereas median weight at the time of procedure has also diminished.
Conclusions: Percutaneous PDA closure appears to be safe and feasible procedures in infants ≤2 kg. The incidence of major adverse events has continued to decline over the years and seems to have a strong correlation with individual center case volumes and expertise.
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| http://dx.doi.org/10.1542/peds.2023-061460 | DOI Listing |
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