Transcatheter PDA closure in preterm: Where do we stand? A prospective multicenter French survey

Abstract

Introduction

Transcatheter persistent ductus arteriosus (PDA) in extremely-low-birth-weight infants has proved to be feasible and safe but midterm outcomes data are scarce. We report herein results from the French nationwide Premiclose registry.

Objective

We report herein results from the French nationwide Premiclose registry.

Methods

All infants who attempted device PDA closure at a procedural weight < 2 kg were prospectively included from 7 tertiary institutions between October 2017 and June 2022. Demographic and procedural data were reviewed as well as respiratory and cardiac follow-up.

Results/Expected results

In total, 274 patients (mean birth weight: 812 ± 213 grams, mean gestational age: 25.8 ± 1.9 weeks) were included. Mean procedural age and weight were 31 ± 12 days and 1250 ± 330 grams respectively. Patients were all symptomatic with a hemodynamically significant PDA. Procedure was performed under both fluoroscopy (fluoro time: 4.5 ± 4 min) and transthoracic echocardiography guidance in all patients; 240 (87.6%) procedures were contrast free. Successful PDA closure was achieved in 97%. Complications occurred in 10 patients, with major adverse events in 3 (1.1%) consisting in device embolization in 2 and tamponnade in 1. There was no procedural death. Post ligation cardiac syndrome was noted in 4% and escalation of respiratory support in 20% of the cases. During follow-up, 8 late complications were reported with 3 patients requiring aortic coarctation treatment and one patient awaiting LPA stenosis treatment. Over time, significantly smaller patients were treated with significantly lower complications. Neurologic assessment is ongoing and will be presented.

Conclusion/Perspectives

Our large series confirms favorable results of transcatheter PDA closure in extremely-low-birth-weight infants, along with demonstrating learning curve, high procedural success, low procedural complications and low rate of post ligation cardiac syndrome but escalation in respiratory support. Late cardiac complications were few but long-term follow-up remains mandatory.