M. Gloanec, F. El Louali, C. Gran, M. Lenoir, V. Fouilloux, C. Ovaert
{"title":"体重2 - 6公斤患者的动脉导管未闭。手术与经导管闭合的单中心比较","authors":"M. Gloanec, F. El Louali, C. Gran, M. Lenoir, V. Fouilloux, C. Ovaert","doi":"10.1016/j.acvdsp.2023.07.023","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Objective</h3><p>This study aims to evaluate recent practices in our department and eventually prove the non-inferiority of transcatheter closure in this population.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 % (<em>n</em> <!-->=<!--> <!-->24/31) for the transcatheter group versus 96,43 % (<em>n</em> <!-->=<!--> <!-->27/28) for the surgical group. Complication rate was 29 % (<em>n</em> <!-->=<!--> <!-->8) and 7,14 % (<em>n</em> <!-->=<!--> <!-->2) respectively. One major adverse event was observed in the percutaneous group (3,2 %). Hospitalisation stay was longer in the surgical group (<em>p</em> <!--><<!--> <!-->0,0001). Surgery might be more expensive (<em>p</em> <!--><<!--> <span>0,0001). In univariate analysis, pre-procedural ventilation was a risk factor for complications (</span><em>p</em> <!-->=<!--> <!-->0,04).</p></div><div><h3>Conclusion/Perspectives</h3><p>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.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 4","pages":"Pages 283-284"},"PeriodicalIF":18.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Patent ductus arteriosus closure in patients weighing 2 to 6 kilos. Monocentric comparison between surgical and transcatheter closure\",\"authors\":\"M. Gloanec, F. El Louali, C. Gran, M. Lenoir, V. Fouilloux, C. Ovaert\",\"doi\":\"10.1016/j.acvdsp.2023.07.023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Objective</h3><p>This study aims to evaluate recent practices in our department and eventually prove the non-inferiority of transcatheter closure in this population.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 % (<em>n</em> <!-->=<!--> <!-->24/31) for the transcatheter group versus 96,43 % (<em>n</em> <!-->=<!--> <!-->27/28) for the surgical group. Complication rate was 29 % (<em>n</em> <!-->=<!--> <!-->8) and 7,14 % (<em>n</em> <!-->=<!--> <!-->2) respectively. One major adverse event was observed in the percutaneous group (3,2 %). Hospitalisation stay was longer in the surgical group (<em>p</em> <!--><<!--> <!-->0,0001). Surgery might be more expensive (<em>p</em> <!--><<!--> <span>0,0001). In univariate analysis, pre-procedural ventilation was a risk factor for complications (</span><em>p</em> <!-->=<!--> <!-->0,04).</p></div><div><h3>Conclusion/Perspectives</h3><p>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.</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":\"15 4\",\"pages\":\"Pages 283-284\"},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023002446\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023002446","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Patent ductus arteriosus closure in patients weighing 2 to 6 kilos. Monocentric comparison between surgical and transcatheter closure
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.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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