Effect of Intravenous Calcium Administration During Transcatheter PDA Closure in ELBW Infants.
Presenter
Neil C Tailor, M.D., University Of Tennessee /Le Bonheur Children's Medical Center, Memphis, TN
Neil C Tailor, M.D.1, Ranjit Philip, M.D.1, Evan Harvey, M.D.1, Genevieve Dupuis, CRNA1, Benjamin R. Waller III, M.D.2, Nathan Stecchi, RDCS1 and Shyam K. Sathanandam, M.D., FSCAI2, (1)University Of Tennessee /Le Bonheur Children's Medical Center, Memphis, TN, (2)Le Bonheur Children's Hospital, Memphis, TN
Keywords: Cardiogenic shock, Hemodynamic support, Occlusion Devices and Pharmacotherapy
Background
:
Surgical ligation of the patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has been replaced by transcatheter PDA closure (TCPC) at our institution. Observational studies have shown a decrease in the rate of post-ligation syndrome (PLS) from 40% to less than 4% with TCPC. However, a transient decrease in left ventricular ejection fraction (EF) immediately following TCPC has been observed. In this study, we describe the change in EF immediately following TCPC, its clinical significance, and estimate whether procedural intravenous administration of Calcium Chloride (CaCl) can prevent this decrease in EF following TCPC.
Methods
:
Since 2019, our institution has administered a bolus of intravenous CaCl (10 mg/kg) at the end of each TCPC procedure for all ELBW infants. A retrospective review of ELBW infants that underwent TCPC between Jan 2019-Dec 2019 was performed and compared to ELBW infants who underwent TCPC prior to this period (Jan 2015-Dec 2018). All patients had a transthoracic echocardiogram (TTE) during TCPC and 4-6 hours post-TCPC. Those who had >20% reduction in EF had a repeat TTE at 24-hours post-TCPC.
Results
:
A total of 111 ELBW infants underwent TCPC between Jan 2015-Dec 2019 at our institution, with 40 patients having received CaCl. Recent patients underwent TCPC at an earlier age (21 ± 9.1 vs. 29 ± 11.7 days; P=0.025). The procedure success rate was higher and adverse event rate lower in 2019 compared to before. The % decrease in EF before 2019 compared to procedures performed in 2019 was 8.2 ± 7.7 % vs. 4.9 ± 8.5 % (P=0.087) respectively, which did not reach statistical significance. However, significantly more patients had a > 20% decrease in EF (9.8% vs. 5%; P=0.011) and PLS (5.6% vs. 2.5%; P<0.01) when CaCl was not administered.
Conclusions
:
TCPC in ELBW is feasible (98% success rate) with low incidence of serious adverse events (3.6%). The incidence of PLS is low (4.5%) and can be further lowered by administering CaCl. Though decreased EF cannot be totally prevented by CaCl, the incidence of significantly decreased EF can be prevented by its use. Therefore, the use of CaCl during TCPC in ELBW infants may have a role in improving acute outcomes following the procedure.