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Percutaneous Closure of Patent Ductus Arteriosus in Infants 1.5 kg or Less: A Meta-Analysis
Adrianne Rahde Bischoff1, Bonny Jasani2, Shyam K Sathanandam3
1Department of Pediatrics, University of Iowa, Iowa City, IA.
Insights
Percutaneous patent ductus arteriosus closure is safe and effective in infants weighing 1.5 kg or less, demonstrating high technical success rates. This minimally invasive procedure offers a promising option for treating congenital heart defects in very low-birth-weight infants.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common condition in premature infants.
- PDA can lead to significant complications, including respiratory distress and necrotizing enterocolitis.
- Percutaneous closure offers a less invasive alternative to surgical intervention.
Purpose of the Study:
- To evaluate the technical success and safety of percutaneous patent ductus arteriosus closure in infants weighing 1.5 kg or less.
- To analyze adverse events associated with the procedure.
- To explore factors influencing procedural success, such as patient weight and age.
Main Methods:
- A systematic review and meta-analysis of studies published from inception to April 2020.
- Inclusion criteria: percutaneous PDA closure in infants ≤1.5 kg.
- Data extraction and analysis using a random-effects model; subgroup analysis for infants ≤6.0 kg.
Main Results:
- Technical success rate of 96% in infants ≤1.5 kg.
- Overall adverse event rate of 27%, with major adverse events at 8%.
- Procedural success increased as intervention weight decreased over time; inverse relationship between technical failure and age.
Conclusions:
- Percutaneous PDA closure is feasible and safe in infants ≤1.5 kg.
- High procedural success rates are achievable even in very small infants.
- The procedure is associated with a low incidence of major adverse events.
Objective:
To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg.
Study Design:
A systematic review and meta-analysis was performed. Data sources included Scopus, Web of Science, Embase, CINAHL, Cochrane, and PubMed from inception to April 2020. Publications were included if they had a clear definition of the intervention as percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. Data extraction was independently performed by multiple observers. Primary outcome was technical success and secondary outcomes were adverse events (AEs). Subgroup analysis was performed in infants ≤6.0 kg. Data were pooled by using a random-effects model.
Results:
We included 28 studies, including 373 infants ≤1.5 kg and 69 studies enrolling 1794 infants ≤6.0 kg. In patients ≤1.5 kg, technical success was 96% (95% CI, 93%-98%; P = .16; I2 = 23%). The overall incidence of AE was 27% (95% CI, 17%-38%; P < .001; I2 = 70%) and major AEs was 8% (95% CI, 5%-10%; P = .63; I2 = 0%). There were 5 deaths related to the procedure (2%; 95% CI, 1%-4%; P = .99; I2 = 0%); 4 of these deaths occurred in infants <0.8 kg. The probability of technical failure was inversely related to age at the time of the procedure (OR, 0.9; 95% CI, 0.830-0.974; P = .009). Weight at intervention has decreased over time and procedural success has increased.
Conclusions:
Percutaneous patent ductus arteriosus closure is feasible in infants ≤1.5 kg with few major AEs. The procedural success rate is high, despite performing the intervention in smaller patients.
Prospero Registration:
CRD42020145230.
