206. Outcomes of Different Management Approaches for Preterm Infants with Patent Ductus Arteriosus: Implications for Optimal Timing of Surgical Closure
Presented During: Precision Medicine in Congenital Heart Disease*
University of Texas - Houston
Houston, TX
United States - Contact Me
Associate Professor of Cardiovascular Surgery
Associate Chief of Pediatric and Congenital Cardiac Surgery
Director of Neonatal Cardiac Surgery
Seoul St.Mary's Hospital
South Korea - Contact Me
My name is Won Young Lee and I am an assistant professor at the pedatric cardiac surgery department in Seoul St.Mary's hospital. I'm interested in PDA surgery, ICU team care, and prenatal diagnosis.
Monday, May 8, 2023: 8:30 AM - 8:45 AM
15 Minutes
Los Angeles Convention Center
Room: 403B
Abstract
Objective: To evaluate neonatal outcomes depending on different treatment strategies for hemodynamically significant patent ductus arteriosus (hsPDA) in preterm very-low-birth-weight (VLBW) infants, in regard to treatment time point.
Methods: This retrospective cohort study was conducted including 430 preterm infants with PDA (186 hsPDA, 43.3%) born between September 2014 and January 2021. Outcomes were compared between treatment strategies (277 conservative vs 153 active). To identity the optimal timing of surgical closure, surgical patients were classified in three subgroups: early primary closure (≤14 post-natal age), late primary closure (>14 post-natal age), and secondary closure after failed pharmacological closure. Adjusted linear logistic regression was conducted to analyze risk factors for in-hospital death, bronchopulmonary dysplasia, post-ligation cardiac syndrome, and acute kidney injury. Significant risk factors were adjusted to identify the optimal period for surgical closure by non-linear regression model.
Results: Active treatment group showed significantly lower in-hospital death compared to the conservative treatment group in overall (adjusted odd ratio (aOR), 0.29; p=0.002) and when subanalyzed in infants with hsPDA (aOR, 0.22; p=0.003). With non-linear regression, the primary surgical closure group presented lower probability for the composite outcome of in-hospital death or bronchopulmonary dysplasia when postmenstrual age was greater than 28 weeks, compared to the secondary closure group. In terms of postoperative complications, the probability for composite outcome of post-ligation cardiac syndrome or acute kidney injury was also lower in the primary closure group when postmenstrual age was less than 32 weeks, compared to the secondary closure group. At postmenstrual age 28 to 32 weeks, early primary closure group experienced the most benefit in terms of in-hospital death or bronchopulmonary dysplasia (early 51.5% vs late 82.1% vs secondary 82.3%, p<0.001) and post-ligation syndrome or acute kidney injury (early 17.8% vs late 22.6% vs secondary 38.4%, p<0.001).
Conclusion: Considering in-hospital death, active treatment is recommended in VLBW infants with hsPDA. In particular, primary surgical closure rather than secondary closure provides maximal benefit and minimal risk of surgery at postmenstrual age 28 to 32 weeks, implying that this could serve as the optimal timing for primary surgical closure of hsPDA in VLBW infants.
Methods: This retrospective cohort study was conducted including 430 preterm infants with PDA (186 hsPDA, 43.3%) born between September 2014 and January 2021. Outcomes were compared between treatment strategies (277 conservative vs 153 active). To identity the optimal timing of surgical closure, surgical patients were classified in three subgroups: early primary closure (≤14 post-natal age), late primary closure (>14 post-natal age), and secondary closure after failed pharmacological closure. Adjusted linear logistic regression was conducted to analyze risk factors for in-hospital death, bronchopulmonary dysplasia, post-ligation cardiac syndrome, and acute kidney injury. Significant risk factors were adjusted to identify the optimal period for surgical closure by non-linear regression model.
Results: Active treatment group showed significantly lower in-hospital death compared to the conservative treatment group in overall (adjusted odd ratio (aOR), 0.29; p=0.002) and when subanalyzed in infants with hsPDA (aOR, 0.22; p=0.003). With non-linear regression, the primary surgical closure group presented lower probability for the composite outcome of in-hospital death or bronchopulmonary dysplasia when postmenstrual age was greater than 28 weeks, compared to the secondary closure group. In terms of postoperative complications, the probability for composite outcome of post-ligation cardiac syndrome or acute kidney injury was also lower in the primary closure group when postmenstrual age was less than 32 weeks, compared to the secondary closure group. At postmenstrual age 28 to 32 weeks, early primary closure group experienced the most benefit in terms of in-hospital death or bronchopulmonary dysplasia (early 51.5% vs late 82.1% vs secondary 82.3%, p<0.001) and post-ligation syndrome or acute kidney injury (early 17.8% vs late 22.6% vs secondary 38.4%, p<0.001).
Conclusion: Considering in-hospital death, active treatment is recommended in VLBW infants with hsPDA. In particular, primary surgical closure rather than secondary closure provides maximal benefit and minimal risk of surgery at postmenstrual age 28 to 32 weeks, implying that this could serve as the optimal timing for primary surgical closure of hsPDA in VLBW infants.
Presentation Duration
7 minute presentation, 7 minute discussion