Comparison of venous approach and conventional approach in children undergoing percutaneous patent ductus arteriosus closure

Background

The standard method for the closure of PDA is the conventional method, where both arterial and venous access are obtained. Patent ductus arteriosus can be closed successfully via venous-only approach.

Objectives

To compare the outcomes of the venous approach and combined arterial and venous approach (conventional approach) among children undergoing percutaneous patent ductus arteriosus device closure at Sahid Gangalal National heart center, Kathmandu, Nepal.

Methods

A total of 248 children <15 years of age with a diagnosis of PDA were included in this retrospective observational study. Echocardiography was used for the selection of patients. We compared the venous approach and combined arterial and venous approach (conventional approach) of PDA device closure in these patients.

Results

A total of 248 children with age groups of 6 months to 14 years were enrolled during the study period. The venous-only approach (group B) was used in 96 patients, and the conventional approach (group A) was used in 152 patients. Baseline characteristics, clinical characteristics, and clinical outcomes in terms of success rate, complications, procedure time, fluoroscopic time, and contrast used were compared between the two groups.

The rate of successful closure in group A and group B patient groups were 96.7 % and 100 %, respectively. The mean procedure time was significantly lesser in group B as compared to group A (25 ± 6.6 min in group B vs. 52 ± 10.4 min in group B, p value ≤ 0.001). The mean fluoroscopy time was also significantly lesser in group B as compared to group A (5 min ± 1.728 in group B vs. 6.5 min ± 2.3 in group A, p-value <0.001). Similarly, the total amount of contrast used was also significantly lesser in group B as compared to group A (24.2 ml ± 11.8 in group B vs. 30ml ± 14.45, p value = 0.001). The complication rate was 11.2 % (n = 17) in group A vs 11 % (n = 11) in group B patient groups.

Conclusion

The venous-only approach can be used as a method of closing PDA as it has lesser procedure time, fluoroscopic time, and lesser amount of contrast used. However, proper patient selection is important prior to performing device closure.