Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants

Shyam Sathanandam, Kaitlin Balduf, Sandeep Chilakala, Kristen Washington, Kimberly Allen, Christopher Knott-Craig, Benjamin Rush Waller, Ranjit Philip

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. Methods: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. Results: Eighty ELBW infants (median procedure weight: 1060 [range 640–2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650–1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2–9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5–4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. Conclusions: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number1
DOIs
StatePublished - Jan 1 2019

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Extremely Low Birth Weight Infant
Patent Ductus Arteriosus
Ligation
Weaning

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants. / Sathanandam, Shyam; Balduf, Kaitlin; Chilakala, Sandeep; Washington, Kristen; Allen, Kimberly; Knott-Craig, Christopher; Rush Waller, Benjamin; Philip, Ranjit.

In: Catheterization and Cardiovascular Interventions, Vol. 93, No. 1, 01.01.2019, p. 89-96.

Research output: Contribution to journalReview article

Sathanandam, S, Balduf, K, Chilakala, S, Washington, K, Allen, K, Knott-Craig, C, Rush Waller, B & Philip, R 2019, 'Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants', Catheterization and Cardiovascular Interventions, vol. 93, no. 1, pp. 89-96. https://doi.org/10.1002/ccd.27808
Sathanandam, Shyam ; Balduf, Kaitlin ; Chilakala, Sandeep ; Washington, Kristen ; Allen, Kimberly ; Knott-Craig, Christopher ; Rush Waller, Benjamin ; Philip, Ranjit. / Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 93, No. 1. pp. 89-96.
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abstract = "Background: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. Methods: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. Results: Eighty ELBW infants (median procedure weight: 1060 [range 640–2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650–1760 g). There was greater increase in RSS following SLP compared to TCPC (76{\%} vs. 18{\%}; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95{\%}CI: 2.2–9.4, P < 0.01 and OR = 2.86, 95{\%}CI: 1.5–4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7{\%}. Conclusions: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.",
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AU - Sathanandam, Shyam

AU - Balduf, Kaitlin

AU - Chilakala, Sandeep

AU - Washington, Kristen

AU - Allen, Kimberly

AU - Knott-Craig, Christopher

AU - Rush Waller, Benjamin

AU - Philip, Ranjit

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N2 - Background: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. Methods: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. Results: Eighty ELBW infants (median procedure weight: 1060 [range 640–2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650–1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2–9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5–4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. Conclusions: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.

AB - Background: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. Methods: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. Results: Eighty ELBW infants (median procedure weight: 1060 [range 640–2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650–1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2–9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5–4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. Conclusions: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.

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