Transcatheter Ductal Closure in the Very Low Birth Weight (VLBW) Premature Infant: Initial Lessons Learned.

Background:
Transcatheter ductal occlusion in very low birth weight (VLBW) infants is possible. This population poses significant procedural challenges.

Methods:
Experience with ductal occlusion using the Microvascular plug (MVP) in VLBW infants (3/18-1/19) was reviewed. A pre-procedural protocol to minimize morbidity was developed. Pre & post procedural meetings were conducted among the neonatal, anesthesia, nursing & interventional staff. Co-morbidities & homeostasis issues were discussed. A checklist & management plan were developed. Patient & ductal profile, procedural metrics & early outcomes were analyzed.

Results:
13 VLBW infants (median birth wt 807 gms, range 485-1429; cath wt 1235 gms, range 770-2545) underwent successful closure with the MVP (5 mm in 11 implants and 3 mm in 2) based on PDA dimensions of: median min diam 2.57mm(1.4-3.4) and median ductal length 12.0 mm(6.0-14.0). All procedures were performed transvenously with a 4 Fr system. Intraprocedural echo in all showed complete ductal occlusion & no significant obstruction in the aorta & pulmonary arteries. While cath lab time was 154 ± 45.3 min, actual procedure time was 68 ± 22.8 min. Flouro time was 7.8 ± 3.41 min & contrast used was 3.2 ± 3.12 cc. Improvements in hemodynamics, ventilation settings or x-rays were seen in all pts. Complications in 2 included left upper lobe collapse & wire perforation. Improvements in draping, warming, imaging, & ventilatory management were made with each subsequent procedure.

Conclusions:
Transcatheter ductal occlusion with the MVP can be performed effectively in VLBW infants with early clinical improvement. Complications can be mitigated with a multidisciplinary approach. Studies to confirm efficacy & safety are warranted.