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Risk factors associated with device embolisation or malposition during transcatheter closure of patent ductus
Zeeshan A Mumtaz1, Pramod Sagar1, Kothandam Sivakumar1
1Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
Insights
Device embolisation during transcatheter duct closure occurs in 4% of cases, particularly in infants with tubular ducts and high pulmonary pressures. Careful technique and device selection are crucial to minimize risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Device embolisation is a significant complication of transcatheter duct closure.
- Identifying risk factors is crucial for improving patient safety.
Purpose of the Study:
- To analyze the risk factors associated with device embolisation during transcatheter duct closure.
Main Methods:
- Retrospective analysis of demographic, echocardiographic, hemodynamic, and procedural data from 376 transcatheter duct closures over 8 years.
- Comparison of procedures with and without device embolisation.
Main Results:
- Fifteen embolisations (4%) occurred, primarily in infants under 6 months.
- Higher risk associated with tubular ducts, vascular plugs, and undersized devices.
- Pulmonary artery: aortic pressure ratio was 0.78 ± 0.22.
Conclusions:
- Younger infants, tubular ducts, vascular plugs, and undersized devices are significant risk factors for embolisation.
- High pulmonary artery pressures increase risk.
- Precise measurements, appropriate device selection, and careful technique are essential to minimize embolisation.
Background:
Device embolisation is a serious adverse event during transcatheter duct closure. This study analyses risk factors for embolisation.
Methods:
Demographic parameters, echocardiographic anatomy, haemodynamics, and procedural characteristics of consecutive duct closures in a tertiary centre over 8 years were analysed. Procedures complicated by embolisation were compared to uncomplicated procedures.
Results:
Fifteen embolisations occurred during 376 procedures. All except one embolisation were in infants. The pulmonary artery: aortic pressure ratio was 0.78 ± 0.22. Embolisation was seen significantly more commonly in Type C tubular ducts. Vascular plugs were more significantly associated with embolisations. Logistic regression analysis showed device embolisation was significantly higher in age group of < 6 months compared to 6-12 months (p = 0.02), higher in those with tubular ducts versus conical ducts (p = 0.003), use of vascular plugs compared to conventional duct occluders (p = 0.05), and in duct closure with undersized devices (p = 0.001). There was no in-hospital mortality. Three patients needed surgical retrieval while others were successfully managed in catheterisation laboratory.
Conclusions:
Device embolisation complicates 4% of transcatheter duct closures, with need for surgery in one-fifth of them. Larger ducts with high pulmonary artery pressures in younger and smaller infants are more often associated with device embolisation. Tubular ducts are more prone for embolisation compared to usual conical ducts. Softer vascular plugs are often associated with embolisations. Intentional device undersizing to avoid vascular obstruction in small patients is a frequent risk factor for embolisation. Precise echocardiographic measurements, correct occluder choice, proper technique and additional care in patients with high pulmonary artery pressures are mandatory to minimise embolisations.
