Abstract 16551: Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants - How Young is Too Young?

Abstract

Background: Transcatheter patent ductus arteriosus (PDA) closure (TCPC), has been shown to be feasible and safe for infants as small as 700 grams or even smaller. Hypothesis: The corrected gestational age of the infant may be a better representation of tissue maturity than the weight of the infant. This study was aimed to explore the outcomes of TCPC based not just on weight, but also on the age of the infant. Methods: This was a retrospective study including infants born at gestational age < 28 weeks who underwent TCPC between Jan-2012 and May-2020 and weighed < 3 kg at the time of the procedure. The study period was divided into four-time blocks. Success and complication rates were compared for those who underwent the procedure at < 28 days to those infants that underwent TCPC >28 days of age. Results: In study period, TCPC was attempted on 241 infants that satisfied the inclusion criteria, with a 99.1% success rate. There was no difference in success rates based on the age at TCPC (99.3% vs. 99% for procedural age < 28 days vs. >28 days respectively; P=0.82). Overall, 140 infants underwent TCPC at < 28 days of age, 29 of whom were < 14 days, and 54 infants underwent TCPC between 15 and 21 days of age. The median age at TCPC progressively decreased from 60 days of life (14-211 days) between January 2012 and December 2014 to 18 days (8-38 days) between August 2019 and May 2020 (P < 0.00001). Similarly, the weight at TCPC decreased over the same time periods (median 1985 grams vs. 900 grams; P < 0.00001). Procedure-related complication rates were similar for those < 28 days vs. >28 days of age at the time of TCPC (2.8% vs. 4.9% respectively; P=0.42). Conclusions: It is feasible and safe to perform TCPC after the first week of life for infants born < 28 weeks’ gestation. As experience grows, more infants are referred to earlier after birth which translates to performing TCPC on smaller infants. The benefits of early TCPC have to be determined in order for this therapy to be advocated routinely for all premature infants.