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Percutaneous Closure of the Patent Ductus Arteriosus in Very-Low-Weight Infants
Danielle Scerbo1,2, Clifford L Cua3,4, Brian K Rivera2
1The Ohio University Heritage College of Osteopathic Medicine, Athens, OH.
Insights
Percutaneous closure offers a new option for very-low-weight infants with patent ductus arteriosus (PDA). This review examines its safety and effectiveness compared to traditional treatments.
Area of Science:
- Neonatal Medicine
- Interventional Cardiology
- Pediatric Surgery
Background:
- Prolonged patent ductus arteriosus (PDA) poses risks, driving the search for safer closure methods.
- Traditional treatments like drug therapy and surgical ligation have known complications.
- Percutaneous closure is gaining traction due to device and procedural advancements.
Purpose of the Study:
- To review percutaneous PDA closure in very-low-weight infants (≤1,500 g).
- To compare percutaneous closure with traditional and conservative management options.
- To analyze the risk profile of percutaneous PDA closure in this vulnerable population.
Main Methods:
- Characterization of traditional PDA treatments and conservative management.
- Overview of percutaneous closure procedures, including thrombotic complication reduction and novel device use.
- Systematic review and meta-analysis of percutaneous PDA closure in very-low-weight infants.
Main Results:
- Emerging feasibility and safety data support percutaneous PDA closure.
- A novel FDA-approved device is available for percutaneous closure.
- Systematic review and meta-analysis provide insights into risk profiles.
Conclusions:
- Percutaneous closure is a viable alternative for very-low-weight infants with PDA.
- Further research, including randomized controlled trials, is needed to optimize PDA care.
- Understanding optimal PDA management remains an evolving area.
Abstract:
In view of the known complications of drug therapy and open surgical ligation, and the potential for prolonged patent ductus arteriosus (PDA) exposure to be harmful, health care practitioners have sought new approaches to achieve definitive ductal closure. Interest in percutaneous (catheter-based) PDA closure has emerged within the neonatal community as a viable treatment option, because it has been fueled by recent procedural and device modifications, as well as mounting feasibility and safety data. Herein, we provide a contemporary review of percutaneous PDA closure among infants at the crux of the medical debate-very-low-weight infants (≤1,500 g), including: 1) characterization of traditional PDA treatments (drug therapy, open surgical ligation) and conservative (nonintervention) management options; 2) a general overview of the major procedural steps of percutaneous ductal closure, including efforts to reduce thrombotic complications and the emergence of a novel US Food and Drug Administration-approved device; 3) a systematic review and meta-analysis to better understand risk profiles of percutaneous PDA closure in this population; and 4) discussion of current gaps in our understanding of optimal PDA care, including the critical need for well-designed, randomized, controlled clinical trials.
