Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

Annina Dietrich,Walter Knirsch,Daniel Quandt,Oliver Kretschmar

doi:10.32604/chd.2021.017232

Abstract

Objectives: To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus (PDA) in children. Background: National antibiotic prophylaxis (AP) guideline for infective endocarditis changed after 2009, the effect on practice of PDA closure is unknown. Methods: Observational single center study analyzing follow-up of PDA closure comparing two time periods before (2002–2009) and after (2010–2019) changes in AP guideline. Results: 332 patients (68.1% female), median (interquartile range) age 3.0 years (1.5–5.7) and body weight 14.0 kg (10.0–19.3), were enrolled. PDA morphology was conical type A (50.3%), window type B (1.2%), tubular type C (40.1%), complex type D (2.1%), elongated type E (0.9%) and other (5.4%). Minimal PDA diameter and length were 1.9 mm (1.3–2.5) and 8.0 mm (6.2–10.2). PDA was closed using coils (56.3%), Amplatzer Duct Occluders (41.9%) and others (1.8%). Complete closure rate was 61.1% at catheter intervention, 72.3% on day 1, 87.7% after 6 months and 98.4% at last follow-up on echocardiography. Moderate complication rate (severity level 3) was 4.2% and major complication rate (severity level 4) 0.3%, with no catastrophic complications (severity level 5). Annual PDA closure rate declined in the second time period (22.6/year vs. 15.5/ year, p = 0.018), PDA size increased (1.6 mm vs. 2.0 mm, p = 0.002) and proportion of coils decreased (72.4% vs. 37.1%, p < 0.001). Conclusions: Interventional closure of PDA is associated with excellent closure rates during follow-up (>98%) and only a small number of complications leading to reintervention or surgery. Change in AP guidelines changed indication for and practice of PDA closure.

Highlights

Patent ductus arteriosus (PDA) is routinely closed by surgical ligation or catheter-based device procedure
Annual PDA closure rate declined in the second time period (22.6/year vs. 15.5/ year, p = 0.018), PDA size increased (1.6 mm vs. 2.0 mm, p = 0.002) and proportion of coils decreased (72.4% vs. 37.1%, p < 0.001)
Interventional closure of PDA is associated with excellent closure rates during follow-up (>98%) and only a small number of complications leading to reintervention or surgery

Summary

Introduction

Patent ductus arteriosus (PDA) is routinely closed by surgical ligation or catheter-based device procedure. Even in small and preterm infants, interventional PDA closure has become more frequent [1]. CHD, 2021 transcatheter PDA closure, new devices have continually been introduced, striving for better results, easier access, fewer complications and lower expenses [2]. In addition to the hemodynamic impact of the left-to-right shunt in patients with PDA, the risk of infective endocarditis (IE) is increased [3]. Swiss guidelines for prevention of IE have been adapted to those published by the American Heart Association in 2007 [4], focusing on non-pharmacological prevention rather than intermittent AP [5]. The indication of IE prevention for treatment of PDA was reviewed, as closure of small, hemodynamically non-significant PDA might not be necessary. We hypothesized that the number of PDA closures might have decreased within the last decade, especially for small PDA

Objectives

Methods

Results

Conclusion