Feasibility and success of muscular ventricular septal defect occluders and mushroom-shaped occluders in transcatheter patent ductus arteriosus closure in low-weight children: a propensity score-matched retrospective analysis from a Chinese national regional health center.

Abstract

Muscular ventricular septal defect occluders (MVSDO) have been attempted as an option in low-weight patients with patent ductus arteriosus (PDA). Few studies have assessed the safety of transcatheter patent ductus arteriosus closure (TCPC) using MVSDO. Therefore, we compared the outcomes in low-weight patients who used MVSDO and mushroom-shaped occluder (MSO). Medical records of children under 10 kg (n=417) who underwent TCPC from 2015 to 2021 at a Chinese health center were reviewed. They were divided into MSO (n=372) and MVSDO (n=45) groups. A 1:1 propensity score matching (PSM) was done considering gender, height, weight, body surface area (BSA), PDA diameter, and BSA-corrected PDA diameter. All 45 children in the MVSDO group (mean weight: 5.92 ± 1.32 kg) achieved success immediate occlusion. One MVSDO migrated within 24 hours requiring unplanned surgery. MVSDO significantly ameliorated pulmonary artery hypertension. After PSM, each group comprised 41 children. The MVSDO group had a smaller effect on platelet counts (MVSDO vs. MSO =259.85 ± 114.82 vs. 356.12 ± 134.37, p < 0.001), a reduced incidence of thrombocytopenia (MVSDO vs. MSO = 2 vs. 7, p = 0.001), and a higher rate of residual shunting (MVSDO vs. MSO =16/41 vs. 5/41, p = 0.005), compared with the MSO group. Thrombocytopenia resolved during hospitalization and micro-shunts disappeared by six months. No pulmonary artery or descending aortic secondary stenosis was observed in one-year follow-up. MVSDO using in low-weight children is feasible, with high success and satisfactory postoperative and short-term follow-up outcomes, including lower thrombocytopenia incidence, compared to MSO. Further long-term studies with larger samples are recommended.