O-3
Transitioning From the Cardiac Catheterization Lab to the Bedside for Transcatheter PDA Device Closure in ELBW Infants: A Single-Center Experience
Presenter
Ashley Kiene, MD, The University of Tennessee Health Science Center, Memphis, TN
Ashley Kiene, MD1, Jason Johnson, MD1, Mark Weems, MD1, Neil C Tailor, M.D.2, Matthew Balmut, BSN2, Benjamin R. Waller III, M.D.2, Ranjit Philip, M.D.3 and Shyam K. Sathanandam, M.D., FSCAI2, (1)The University of Tennessee Health Science Center, Memphis, TN, (2)Le Bonheur Children's Hospital, Memphis, TN, (3)University Of Tennessee /Le Bonheur Children's Medical Center, Memphis, TN
Keywords: Congenital Heart Disease (CHD) and Patent Ductus Arteriosus (PDA)
Background
Transcatheter Patent ductus arteriosus (PDA) closure (TCPC) is feasible and safe in infants weighing
< 1 kg. These extremely low birth weight (ELBW) infants are most vulnerable to transport between hospitals and out of their safe environment in the incubator. We aim to describe a single center experience in transitioning the TCPC procedure from the cath lab to the bedside performed in the neonatal intensive care unit (NICU).
Methods
TCPC in ELBW infants has been performed at our center since 2012. In preparation for bedside TCPC in 2021, TCPC was performed for 6-months with transthoracic echo (TTE) guidance avoiding fluoroscopy in the cath lab (e-TCPC). We then transitioned TCPC to the bedside in the NICU (b-TCPC) with the ELBW infant in the incubator using a portable mini-C-Arm for fluoroscopy and TTE to guide the procedure.
Results
A total of 306 ELBW infants underwent TCPC between July 2012 to January 2022. During the transition period in 2021, 22 ELBW infants underwent e-TCPC without fluoroscopy. In January 2022, five ELBW infants have undergone b-TCPC. For e-TCPC, the median procedure weight was 800 grams with no procedural complications and a 91% feasibility rate. In two infants, e-TCPC was abandoned due to poor acoustic windows and the procedure was successfully completed using fluoroscopy. Based on this experience, b-TCPC was performed using a combination of TTE and fluoroscopy with no procedural complications and a 100% feasibility rate. For b-TCPC, the median gestational age was 23 weeks (range 22-24 weeks) and median procedure weight was 680 grams (range 640-800 grams). Procedure time was shorter for b-TCPC than e-TCPC (median 16 vs. 45 minutes; P < 0.01).
Conclusions
In this early clinical experience, it was feasible to perform TCPC at bedside in the NICU in ELBW infants. Currently, a combination of fluoroscopy and TTE are utilized with plans to perform b-TCPC using only TTE guidance. This could allow the operator to travel to various NICUs to perform TCPC at the bedside rather than transporting the infant to the few centers with cath labs that perform this procedure. Bedside TCPC has the potential to expand this therapy to patients who currently undergo expectant PDA management due to the lack of availability of this therapy at the bedside.