P0402 - Patent Ductus Arteriosus Device Closure in Low Birth Weight Premature Infants: A Single Center Experience

Background/Purpose: Premature infants are at increased risk of developing a hemodynamically significant patent ductus arteriosus (PDA), with resulting increased morbidity and mortality. Transcatheter closure of PDA is the treatment of choice in patients weighing > 5 kg; however, as new devices become commercially available, further investigation is warranted in low birth weight premature infants. The primary aim of this study is to describe the outcomes of transcatheter device closure with various devices in infants weighing ≤ 2.5 kg. The secondary aim of this study is to describe echocardiographic characteristics associated with improved patient outcomes following PDA device closure.

Methods: A single-center retrospective review of premature infants weighing ≤ 2.5 kg undergoing PDA device closure from 2016-2019 was performed. Patient charts were reviewed for medical therapies, ventilatory support, catheterization procedural data, and incidence of post-procedure morbidity or mortality. Echocardiograms performed pre-procedure, intra-procedure, and post-procedure were reviewed to describe any anatomic or hemodynamic abnormalities.

Results: Eighteen patients, 61% male, with a median birthweight of 735 g and median weight of 1805 g at time of catheterization were included (Table 1). Fifteen patients (83%) underwent successful PDA device closure with four different devices: 7 Amplatzer Piccolo Occluder (Abbott, Chicago, IL), 4 Amplatzer Vascular Plug II (Abbott, Chicago, IL), 3 Microvascular Plug (Medtronic, Minneapolis, MN), and 1 Nit-Occlud PDA (PFM Medical, Carlsbad, CA). All procedures were performed with echocardiographic assistance (Figure 1) with an average fluoroscopy time of 14.9 minutes and an average of 5.8 mL contrast administered. Thirty-day survival was 100%. Two patients had procedure-related complications: 1 supraventricular tachycardia, 1 pericardial effusion. Three patients had unsuccessful device placement and required surgical ligation. Ten patients developed bronchopulmonary dysplasia (BPD) prior to device closure (defined as an oxygen requirement at 28 days of life): 5 severe, 4 moderate, and 1 mild. Two patients developed mild flow acceleration in the left pulmonary artery post-procedure that self-resolved without intervention. No patients developed signs of descending aorta flow obstruction. Follow-up echocardiograms demonstrate no residual PDA shunts.

Conclusion: PDA device closure is safe, well tolerated, and overall successful in this cohort of small, premature infants. Greater experience is associated with improved procedural success, reflecting the presence of a learning curve for these interventions. Further investigation is warranted to determine whether earlier PDA closure impacts the development of BPD in this population and to compare device closure to both surgical ligation and medical therapy.