D-7 | Outcomes of Patent Ductus Arteriosus Therapies in Patients

Abstract

Presence of a hemodynamically significant PDA in premature infants, especially in <29 weeks is associated with complications like prolonged mechanical ventilation, NEC and IVH. Therapy with IV acetaminophen or NSAIDs for closure is effective in <50% and associated with many complications. Transcatheter PDA closure (TCPC) including Piccolo device approved for infants >700g has shown >95% success without significant complications. There is a lot of practice variability with no management consensus. We compared the outcomes between medical, surgical and device closure in patients of <2000g, including complications. Retrospective review of infants <29 week gestation, who underwent medical/interventional/surgical PDA closure at <2Kg at Nicklaus Children’s Hospital from 1/2010-11/2022. Patients with complex congenital heart defects, coarctation or pulmonary artery stenosis were excluded. TCPC device complications assessed included TV regurgitation, significant LPA or aortic obstruction, device embolization or erosion. Respiratory status calculated as respiratory severity score was also compared. Total of 86 infants born <29 weeks gestation and <2000g at procedure were included. 56% patients failed primary medical therapy and required either TCPC or surgical therapy (43% vs 57%). Medication use was associated with complications including NEC, pulmonary hemorrhage and AKI in 24% patients (n=15). The median gestational age of patients undergoing TCPC was 25+1 (22-28) wks, median weight 1260g (790-1930g), similar to surgical group for gestation and weight (1040g, 600-2000). 36 patients underwent TCPC with Piccolo, the remainder with MVP. Neonates with TCPC showed earlier improvement in respiratory status (RSS 3.6 vs 4.5, p 0.037 ) and earlier extubation (10 days vs. 26 days, p 0.01) compared to surgical ligation. TCPC use was safe and with no significant LPA or aortic stenosis seen with Piccolo device, one with MVP. Moderate TR was seen in one patient following Piccolo device. New NEC was seen in 1 patient after 10 days. TCPC is effective in patients <2000g with earlier improvement in respiratory status compared to surgical ligation, without any significant complications.