Transcutaneous Closure of Persistent Ductus Arteriosus: Complication Rates and Long-term Follow-up, a Single-Centre Retrospective Study

TL;DR

This study examines complication rates and long-term outcomes of a common heart procedure in children, finding that most issues appear quickly but some may develop years later.

Contribution

The study identifies specific risk factors and late complications associated with PDA occlusion using ADO1 devices, suggesting the need for extended monitoring.

Findings

Major complications occurred in 5.1% of patients within 24 hours of the procedure.

2% of patients developed mild to moderate aortic or LPA obstruction at least one year post-procedure.

Late obstruction was associated with younger age and larger ADO1 devices in patients with large ducts.

Abstract

Transcutaneous closure of patent ductus arteriosus (PDA) in childhood is a common procedure. Long-term follow-up by paediatric cardiologists is variable. Identification and classification of postoperative complications may enable targeted follow-up and timelier discharges. This study aimed to characterize complication rates and assess discharge timing.

This is a single-centre retrospective study of paediatric patients (aged 0-15 years) who underwent a transcutaneous closure of a PDA between January 2006 and December 2015.

A total of 156 patients who underwent interventional occlusion of a PDA were included. Complications were seen in 18 of 156 (12%) patients. High-grade complications occurred in 8 of 156 (5.1%) patients; these included device embolization, failure requiring surgical closure, or repeated interventional closure. Moderate to low-grade complications including flow acceleration in the aorta and left pulmonary artery (LPA) occurred in 10 of 156 (6.4%) patients. Fourteen of 18 (77%) complications were immediately apparent. Late mild to moderate obstruction of the descending aorta or LPA occurred in 3 of 156 (2%) patients. Later obstruction occurred in the Amplatzer ductal occluder 1 (ADO1) group only with large (4.5-5 mm) ducts. The average follow-up time for all patients was 81 (±47) months. Younger age at insertion and larger size of ADO1 devices were associated with later obstruction.

In our cohort, PDA occlusion was associated with a 5.1% major complication rate, which is evident within 24 hours; a further 2% (all treated with ADO1 devices) developed between mild and moderate aortic or LPA obstruction at least 1 year after the procedure. To date, this has not required intervention. It may therefore be prudent to continue longer-term surveillance of patients who have undergone PDA occlusion with the ADO1 device.