218 - Lessons learned from the Implementation of a Percutaneous PDA Closure Program for Preterm infants in a Neonatal Hemodynamics Center

Poster Number: 218
Publication Number: 218.329

Rachael M. Hyland, University of Iowa Stead Family Children's Hospital, Coralville, IA, United States; Adrianne R. Bischoff, University of Iowa Stead Family Children's Hospital, Coralville, IA, United States; Amy Stanford, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Danielle R. Rios, University of Iowa Department of Pediatrics, Iowa City, IA, United States; Osamah Aldoss, University of Iowa Stead Family Children's Hospital, Iowa city, IA, United States; Bassel Mohammad Nijres, University of Iowa, Iowa City, IA, United States; Regan Giesinger, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Patrick J. McNamara, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States

Background: Percutaneous patent ductus arteriosus (PDA) closure is becoming the standard of care for definitive PDA closure in extremely preterm infants. The establishment of centers of excellence with close collaboration between neonatologists, hemodynamic specialists, and interventional cardiologists, and with a critical procedural volume, are likely determinants of procedural success. In 2019, the Iowa Percutaneous PDA Closure program was established based on these premises.

Objective: Evaluate the trends of a percutaneous PDA closure program for preterm infants.

Design/Methods: A retrospective chart review was performed to report the trends and characteristics of patients referred for percutaneous PDA closure in a quaternary NICU with an established program (University of Iowa Stead Family Children’s Hospital) between October 2019 and December 2022. Patients < =2kg at the time of device closure and without genetic disease or congenital heart disease were included. The primary outcome was defined as the composite of technical failure and/or major adverse events. Descriptive statistics were used for demographics and clinical data.

Results: A total of 94 patients were referred during the study period and 83 met inclusion criteria. Figure 1 depicts the exclusions as well as procedural outcomes. All patients, with a hemodynamically significant PDA based on an echocardiography score, were referred after failed or contraindication to further medical therapy (Fig 2). Percutaneous device closure was performed via femoral venous access with either an Amplatzer Piccolo Occluder or KA micro-plug. All patients were managed from referral through post-operative recovery according to standardized PDA guidelines in collaboration with the Neonatal Hemodynamics team (Fig 3). Table 1 depicts the baseline and periprocedural characteristics of patients undergoing the procedure. Major adverse events occurred in 3 patients with 1 death attributed to the procedure (Fig 1). The primary outcome occurred in 4 (4.8%) of the patients and was not influenced by weight (p=0.992) or postnatal age (p=0.751). Table 2 summarizes the post-procedural outcomes with impaired oxygenation (31%) and hypertension (19%) most common.

Conclusion(s):

PDA device closure was successfully performed in 95% of preterm infants ≤2kg. Overall complication rate was low and not affected by patient size or age. Determinants of the high success rate, despite a vulnerable population, may include adherence to standardized PDA Program Guidelines, high center volume, and close collaboration between neonatology, neonatal hemodynamics, and interventional cardiology.