Percutaneous Closure of the Patent Ductus Arteriosus in Infants <2kg: Insights from the NCDR IMPACT Registry

Adrianne Rahde Bischoff, University of Iowa, United States; Kevin F Kennedy, Saint Lukes Health System, United States; Carl Backes, Nationwide Children's Hospital, United States; Shyam Sathanandam, The University of Tennessee Health Science Center, United States; Patrick J. Mcnamara, University of Iowa, United States

Background: Recent studies suggest that percutaneous patent ductus arteriosus (PDA) closure has expanded to smaller patients with high rates of technical success.

Objectives: Our objective was to assess the incidence of technical failure and major adverse events (MAE) in infants < 2kg undergoing percutaneous PDA closure.

Design/Methods: Patients from the NCRD IMPACT Registry (April 2016-June 2021) were included. Primary outcome was defined as the composite of technical failure and/or MAE. Infants experiencing the composite outcome were compared with those who did not experience it. Modified hierarchical Poisson regression was used to estimate the risk ratio of covariates predicting MAE or composite success endpoints.

Results: We included data from 87 hospitals on 1587 infants < 2kg undergoing attempted percutaneous PDA closure. Median[IQR] gestational age and weight at intervention were 37 [27, 49] days and 1.2 [1.0, 1.6] kg respectively. The composite outcome of MAE and/or technical failure occurred in 85(5.5%) of the patients, who were more likely to have arterial access and had longer procedure times (Tables 1 and 2). The incidence of the composite outcome decreased with weight and age at intervention (Figure 1) and hospitals with higher procedural volume (Table 2). Although median weight at intervention decreased over time, the incidence of MAEs/technical failure also decreased (Figure 2).

Conclusion: There was a high rate of technical success with low risk of MAE in patients < 2kg undergoing percutaneous PDA closure. Center with higher case volumes have lower risk of complications while arterial access is associated with higher incidence of MAEs.