Patent ductus arteriosus closure in patients weighing 2 to 6 kilos. Monocentric comparison between surgical and transcatheter closure

Abstract

Introduction

Transcatheter closure of patent ductus arteriosus (PDA) is expanding due to the fast development of new techniques and new materials. Miniaturization of devices currently allows transcatheter closure of ducts in very small patients. Few published data are however available in the 2 et 6 kilograms population.

Objective

This study aims to evaluate recent practices in our department and eventually prove the non-inferiority of transcatheter closure in this population.

Methods

Observational retrospective monocentric study comparing percutaneous and surgical duct closure in children weighing between 2 et 6 kilos, at the University Hospital of la Timone enfants, Marseille, France. This work is part of a large international study, still on-going. Clinical and catheterization/surgical data were analysed. Success was defined as absent residual shunt. The cost of the procedure, based on reimbursement endorsed by the national social security, was compared.

Results

Between 2014 and 2021, 31 patients weighing 2 to 6 kg, had percutaneous closure and 29 patients had surgical closure of the PDA. Mean age was respectively 20 (± 10) and 13 weeks (± 8), mean weight 4,5 kg (± 1) and 3,5 kg (± 1,3). The success rate was 77,42 % (n = 24/31) for the transcatheter group versus 96,43 % (n = 27/28) for the surgical group. Complication rate was 29 % (n = 8) and 7,14 % (n = 2) respectively. One major adverse event was observed in the percutaneous group (3,2 %). Hospitalisation stay was longer in the surgical group (p < 0,0001). Surgery might be more expensive (p < 0,0001). In univariate analysis, pre-procedural ventilation was a risk factor for complications (p = 0,04).

Conclusion/Perspectives

In our experience, percutaneous closure remained less efficient than surgery in the 2 to 6 kg patients. Results are however promising and the procedure seems safe. The hospital stay is shorter and the procedure might be less expensive. However, our small numbers do not allow us to make strong conclusions. Larger, multicentre studies are needed.