Comparison of two transcatheter device strategies for occlusion of the patent ductus arteriosus.

OBJECTIVES

The present study evaluates two transcatheter closure strategies utilized at a single center and makes recommendations for device selection when occluding the patent ductus arteriosus.

BACKGROUND

A variety of devices are available for transcatheter closure of the patent ductus arteriosus (PDA) but no guidelines exist to guide operator device choice.

METHODS

A total of 132 patients underwent attempted transcatheter PDA closure utilizing one of two consecutive closure strategies between January 2000 and June 2005. Strategy A (n = 64; January 2000-May 2003) utilized Gianturco coils only. Strategy B (n = 68; June 2003-June 2005) utilized a single Gianturco coil for the PDA with a minimal diameter <or=1 mm (n = 28) or an Amplatzer Duct Occluder (ADO) if the PDA diameter exceeded 1 mm (n = 40). Success was defined as complete occlusion on a follow up echocardiogram.

RESULTS

58 of 64 (90.6%) patients treated utilizing strategy A had successful coil implantation. 68 of 68 (100%) patients treated utilizing strategy B had successful coil/device implantation. At follow up echocardiography, 32 of 44 (72.7%) strategy A patients had complete ductal closure, as compared with 57 of 58 (98.3%) strategy B patients (P < 0.0001). Stepwise logistic regression analysis identified closure strategy as the most powerful predictor of procedural success (OR = 85.9; CI 5.6-9.99).

CONCLUSIONS

A transcatheter PDA closure strategy consisting of a single Gianturco coil for PDA <or= 1 mm or an ADO for larger sized PDA (strategy B) achieves superior outcomes compared to the use of coils alone.