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Published on: December 23, 2022
Transcatheter closure of the patent ductus arteriosus: an intention to treat analysis
Bennett J Sheridan1, Cameron J Ward, Benjamin W Anderson
1Queensland Paediatric Cardiac Service, Mater Children's Hospital, Brisbane, Australia.
Insights
Transcatheter closure of patent ductus arteriosus (PDA) is effective. The Amplatzer Duct Occluder (ADO) demonstrated superior complete occlusion rates and lower embolization compared to the Flipper coil (FC), suggesting ADO as a preferred device.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Transcatheter closure is the primary treatment for patent ductus arteriosus (PDA).
- Limited comparative data exists for available closure devices.
- Device selection recommendations vary among clinicians.
Purpose of the Study:
- To compare the efficacy and safety of the Flipper coil (FC) and Amplatzer Duct Occluder (ADO) for PDA closure.
- To evaluate device performance in a pediatric population.
Main Methods:
- Retrospective intention-to-treat analysis of pediatric PDA occlusions from 2003-2011.
- Standard implantation techniques for FC and ADO were employed.
- Device and patient selection were physician-determined.
Main Results:
- Successful occlusion was achieved in 96.2% of attempted cases.
- ADO was used in 66.7% of patients, often for smaller patients with larger PDAs.
- ADO showed a lower embolization rate (0% vs. 6.6%) and higher complete occlusion (100% vs. 73.4%) than FC.
Conclusions:
- Transcatheter PDA closure is safe and effective.
- The ADO appears to be the preferred device for transcatheter PDA closure in the current clinical landscape.
Background:
In patients with patent ductus arteriosus (PDA), transcatheter closure is the current procedure of choice. There are multiple devices available with limited current comparative data and varied recommendations for device selection.
Objective:
To assess the efficacy and safety of the Flipper coil (FC) and the Amplatzer Duct Occluder (ADO).
Methods:
An intention to treat analysis of all children admitted to the catheter laboratory at a single institution for occlusion of PDA from 2003 to 2011 was performed. Patient and device selection were determined by the treating physician. Standard techniques for FC and ADO implantation were used.
Results:
Two hundred and twenty eight children with median weight of 14.2 kg (range; 5.5-68 kg) underwent cardiac catheterisation, with successful occlusion in 96.2% of patients when attempted. In 16 patients, median angiographic PDA diameter of 0.8 mm (range; 0.4-1.2 mm), was considered too small to warrant closure. Eight patients with large PDA's underwent surgical ligation. FC was successfully used in 70 (34.3%) and ADO in 134 (66.7%) patients. ADO patients were smaller (P=0.004) with larger PDA's (P<0.0001) than the FC group. Median fluoroscopy time was longer for ADO patients (10.1 min vs 8.0 min; P<0.0001). ADO had a lower embolisation rate (0% vs 6.6%; P=0.005) and a higher complete occlusion rate at follow-up (100% vs 73.4%; P<0.0001). Length of hospital admission decreased with time in both groups.
Conclusion:
Transcatheter closure of the PDA has a high degree of safety and efficacy. This study suggests that the ADO may be the device of first choice in the current era.
