Transcatheter Closure of Patent Ductus Arteriosus With Severe Pulmonary Artery Hypertension Through Single Venous Approach: a Propensity Score Match Analysis From Long-term Outcomes
Abstract Background: Up to now, transcatheter closure of patent ductus arteriosus(PDA) without severe pulmonary artery hypertension (PAH) has been well established and accepted in clinical practice. However, in PDA patients with severe PAH, transcatheter closure still remains a challenge, regardless of the tremendous advancement in devices and techniques.Methods: We reviewed the records of PDA patients who underwent transcatheter device closure though single femoral venous approach between January 2005 and December 2018. Severe PAH was defined as systolic pulmonary artery pressure (SPAP) measured by a catheter >70mmHg, excluding irreversible severe PAH assessed by trial occlusion. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Results: A total of 29 patients were in severe PAH (SPAH) group after excluding 2 for failing to the trial occlusion, and 468 in non-severe PAH(non-SPAH) group. After matching, 25 patients were in SPAH group, and 39 in non-SPAH group, without any significant difference in baseline characteristics. The median follow-up periods were 57 and 44 months for groups, respectively. No significant difference was noted in the rates of cumulative adverse events in the 2 groups (p=0.208). No poor effects in left ventricular function and residual shunt evaluated by transthoracic echocardiography(TTE) in SPAH group were detected in the short- and long-term follow-up.Conclusion: In the patients with PDA associated with reversible severe PAH, compared to non-severe PAH, transcatheter closure through single venous approach has comparable adverse events rates and successful closure rate, with equivalent results of TTE examination at the short- and long-term follow-up.