A Global Perspective on PDA Management in the Extremely Premature: Shifting Trend Toward Transcatheter Closure.

全球视角下的 PDA 管理极度过早 ： 向跨导管关闭的转变趋势。

• 发表时间: 2023 Jul-Aug
• 来源期刊: J Soc Cardiovasc Angiogr Interv
• DOI: 10.1016/j.jscai.2023.100968
• PMID: 39131651
• 文章类型: Journal Article
• 作者列表: Sathanandam S,McNamara P,Pedra C,Toyoshima K,Malekzadeh-Milani S,Patkai J,Baspinar O,Uslu HS,Promphan W,Khorana M,Wang JN,Lin YC,Fujii T,Mainzer G,Salazar-Lizárraga D,Márquez-Gonzalez H,Popat H,Mervis J,Hong NS,Alwi M,Wonwandee R,Schranz D,Stanimir G,Philip R,Ing F

关键词: global perspective; patent ductus arteriosus; prematurity; transcatheter occlusion

Abstract

Patent ductus arteriosus (PDA) is a frequently encountered defect in infants born extremely premature (≤26 weeks\' gestation). Historically, closure of the PDA was performed using cyclooxygenase inhibitor medications or by surgical ligations. However, the benefits of PDA closure using these therapies have never been demonstrated, albeit studies have previously not focused on the extremely premature infants. Therefore, there was a worldwide trend toward conservative management of the PDA. With improved survival of extremely premature infants, comorbidities associated with the PDA has increased, resulting in finding alternate treatments such as transcatheter patent ductus arteriosus closure (TCPC) for this population. Currently, there is a renewed interest toward selective treatment of the PDA in this high-risk cohort of small infants. This Comprehensive Review article inspects the globally changing trends in the management of the PDA in premature infants, with a special focus on the rising adoption of TCPC. Moreover, this article compiles data from several neonatal networks worldwide to help understand the problem at hand. Understanding the current management of premature infants and their outcomes is fundamentally essential if pediatric cardiologists are to offer TCPC as a viable therapeutic option for this population. This article aims to serve as a guide for pediatric cardiologists on this topic by compiling the results on landmark clinical trials on PDA management and the controversies that arise from these trials. Comparative outcomes from several countries are presented, including interpretations and opinions of the data from experts globally. This is a step toward coming to a global consensus in PDA management in premature infants.

摘要

动脉导管未闭（PDA）是极早产（≤26周妊娠）的婴儿经常遇到的缺陷。历史上,使用环氧合酶抑制剂药物或通过手术结扎来封堵PDA.然而,使用这些疗法关闭PDA的益处从未得到证实，尽管以前的研究并不集中在极早产儿。因此,全球范围内的趋势是对PDA进行保守管理。随着极早产儿生存率的提高，与PDA相关的合并症增加了，从而为该人群找到替代治疗方法，例如经导管动脉导管未闭封堵术（TCPC）。目前,在这一高风险的小婴儿队列中,人们对PDA的选择性治疗产生了新的兴趣.这篇综合评论文章考察了早产儿PDA管理的全球变化趋势，特别关注TCPC的日益普及。此外，本文汇编了来自全球多个新生儿网络的数据，以帮助理解当前的问题。如果儿科心脏病专家要为该人群提供TCPC作为可行的治疗选择，了解早产儿的当前管理及其结局至关重要。本文旨在通过汇编有关PDA管理的具有里程碑意义的临床试验的结果以及这些试验引起的争议，为儿科心脏病专家提供有关该主题的指导。介绍了几个国家的比较结果，包括全球专家对数据的解释和意见。这是迈向早产儿PDA管理全球共识的一步。