Outcomes and Determinant Factors of Percutaneous Transcatheter Occlusion among Children with Patent Ductus Arteriosus in the East Coast Malaysia: A 10 Year Experience

Abstract

Introduction: Transcatheter closure was a well-established procedure in patent ductus arteriosus (PDA). The aim of the study was to determine the outcomes, median time and PDAs closure from diagnosis and the predictive factors which influenced the decision for PDA closure. Material and methods: A 10-year retrospective record review was performed involving patients who had undergone transcatheter closure of PDA from January 2007 to January 2017 at a single centre in the North-eastern of Peninsular Malaysia. Descriptive statistics were used to examine all variables. Kaplan-Meier survival analysis was applied to determine median time for diagnosis and transcatheter closure of PDA. Multiple Cox regression analysis was used to identify predictors for early intervention of PDA closure. Results: A total of 123 patients were recruited with 65.9% of them were predominantly female. The age at the time of diagnosis was between 4-day to 14.5-year-old and median age for undergoing the procedure was 2.6-year-old (range:3-month to 15.8-year-old). The PDA size ranged between 0.2-12mm with 59% of the patients had large size PDA. Successful closure rate was achieved in 96.2 % with 3.8 % having very minimal residual shunt at 2 years post procedure. Complications were noted in 17 patients (4.0% major, 9.8% minor). Overall, the median time to diagnose and to close PDA were 6 months and 16.9 months respectively. Earlier intervention was likely to be performed in younger children (p<0.001) with weight of less than 10 kg (p<0.001). Conclusions: Transcatheter device closure was safe and effective in children with PDA with excellent outcome and minimal complication. Age and weight were the determinant factors for early PDA closure.