90 - Comparison of Echocardiographic Indices of Ventricular Function and Pulmonary Hypertension in Premature Infants After Transcatheter vs. Surgical Closure of the Patent Ductus Arteriosus

Poster Number: 90
Publication Number: 90.303

Carolyn Sommer, Cohen Children's Medical Center, Brooklyn, NY, United States; Siddharth Mahajan, Cohen Children's Medical Center, Queens, NY, United States; Joanna Fishbein, Northwell Health, Plainview, NY, United States; Dipak Kholwadwala, Northwell health, New hyde park, NY, United States; Shilpi M. Epstein, Rocket Pharmaceuticals, Cranbury, NJ, United States; Howard S. Heiman, Cohen Children's Medical Center of Northwell Health, New Hyde Park, NY, United States; Robert Koppel, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Lindsey McPhillips, Atlantic Health System, Ridgewood, NJ, United States; Denise A. Hayes, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States

Background: A hemodynamically significant patent ductus arteriosus (PDA) is common in premature infants. Previously, surgical ligation was the only option for those who had contraindications for or had failed medical therapy, however surgical complications were common. Use of the less invasive transcatheter PDA closure (TCPC) in low weight infants increased since FDA approval of the Amplatzer™ Piccolo Occluder in 2019. Well-described complications of PDA closure include left ventricular (LV) and pulmonary vascular dysfunction.

Objective: We sought to compare post-procedural echocardiographic indices of ventricular function and pulmonary hypertension in premature infants after TCPC vs. surgical ligation.

Design/Methods: Premature infants born at < 28 weeks gestation who underwent TCPC or surgical ligation at < 6 months old were retrospectively analyzed. Echocardiograms performed within 48 hours post-procedure were interpreted by a pediatric cardiologist blinded to the type of PDA closure. Measurements were compared between groups by Fisher’s exact and independent t tests.

Results: Ten surgical ligation and 11 TCPC subjects were identified. Median procedure age and weight were 45 days (interquartile range 23-84), 1.37kg (1.06-1.82) for surgical ligation and 44 days (32-61), 1.39kg (1.15-1.82) for TCPC. Only 1 subject (surgical) had a trivial residual PDA. Four subjects (all surgical) were receiving inotropic medications at the time of the echocardiogram. Mean LV cardiac index calculated by velocity time integrals was significantly lower in the surgical group (2.3 ± 0.5 L/min/m2) vs. TCPC group (3.8 ± 1.2 L/min/m2), p=0.002. Right ventricular (RV) function as measured by tricuspid annular plane systolic excursion indexed to body surface area was significantly lower in the surgical (5.6 ± 1.5 cm/m2) vs. TCPC group (7.1 ± 1.1 cm/m2), p=0.016. Higher pulmonary vascular resistance was suggested by significantly shorter mean pulmonary artery acceleration time (PAAT) in the surgical (42.0 ± 15.7 msec) vs. TCPC group (65.2 ± 13.4 msec), p=0.002. There were no significant differences between groups in RV fractional area change, LV shortening or ejection fractions, PAAT/RV ejection time ratio, or estimation of pulmonary artery pressure (Table 1).Conclusion(s): Certain indices of ventricular function and pulmonary vascular resistance on post-procedural echocardiograms suggest more favorable hemodynamics in premature infants after TCPC compared to surgical ligation of the PDA. Larger studies are needed to further assess these measurements and their relation to clinical outcomes.
Table 1