Follow-up after Percutaneous Patent Ductus Arteriosus Occlusion in Lower Weight Infants

Abstract

To describe longer term outcomes for infants <6kg undergoing percutaneous occlusion of the patent ductus arteriosus (PDA). This was a retrospective cohort study of infants <6kg who underwent isolated percutaneous closure of the PDA at a single, tertiary center (2003-2017). Cardiopulmonary outcomes and device-related complications (eg, left pulmonary artery obstruction) were examined for differences across weight thresholds (very low weight, <3kg; low weight, 3-<6kg). We assessed composite measures of respiratory status during and beyond the initial hospitalization using linear mixed effects models. In this cohort of lower weight infants, 92 of 106 percutaneous occlusion procedures were successful. Median age and weight at procedure were 3.0months (range, 0.5-11.1months) and 3.7kg (range, 1.4-5.9kg), respectively. Among infants with pulmonary artery obstruction on initial postprocedural echocardiograms (n=20 [22%]), obstruction persisted through hospital discharge in 3 infants. No measured variables were associated with device-related complications. Rates of oxygenation failure (28% vs 8%; P<.01) and decreased left ventricular systolic function (29% vs 5%; P<.01) were higher among very low weight than low weight infants. Pulmonary scores decreased (indicating improved respiratory status) following percutaneous PDA closure. Percutaneous PDA occlusion among lower weight infants is associated with potential longer term improvements in respiratory health. Risks of device-related complications and adverse cardiopulmonary outcomes, particularly among very low weight infants, underscore the need for continued device modification. Before widespread use, clinical trials comparing percutaneous occlusion vs alternative treatments are needed.