471 - Post-ligation Cardiac Syndrome and Hemodynamic Changes Following Patent Ductus Arteriosus Closure in Preterm Infants: A Comparison Between Surgical Ligation and Transcatheter Amplatzer Piccolo™ device

Publication Number: 3456.471

Maram Sati, Boston Children's Hospital, Boston, MA, United States; Caroline Pennacchio, UPMC - Mercy, Pittsburgh, PA, United States; Anna West, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Rita M.. Ryan, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Martin L.. Bocks, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: PLCS is a well-recognized complication after surgical closure of a patent ductus arteriosus (PDA) in preterm infants that characterized by acute cardiovascular decompensation within 24 hours following surgical PDA ligation (SPL). With the introduction of the Amplatzer Piccolo™ device, transcatheter PDA closure (TCPC) has emerged as a less invasive alternative, potentially mitigating the physiologic stress associated with surgical ligation. However, data comparing the incidence of PLCS and hemodynamic responses between surgical and transcatheter closure remain limited.

Objective: To assess the incidence of PLCS in patients who underwent SPL vs TCPC and assess the left ventricular systolic function on echocardiogram following intervention. It also investigates the effect of transcatheter device closure of PDA and the physiological changes in the first 72 hours post procedure.

Design/Methods: A retrospective single-center cohort study was conducted between January 2016 and December 2022 in preterm infants who underwent PDA closure. Infants were grouped by closure technique. The incidence of PLCS was defined as both escalation of inotropic support and ≥20% increase in FiO₂ within 24 hours. Echocardiograms were reviewed for left ventricular ejection fraction (LVEF) before and after closure in the Piccolo group. Vital signs (heart rate, respiratory rate, systolic and diastolic blood pressure) were recorded at baseline and 24, 48, and 72 hours post-closure.

Results: Seventy infants were included (20 preterm infants underwent surgical ligation and 50 underwent transcatheter device closure.). PLCS occurred in 3/20 (15%) following surgical ligation and none after Piccolo closure (p = 0.02). Following surgery, heart rate and respiratory rate decreased over 24-48 h, consistent with transient postoperative depression and reduced cardiac output, while blood pressure remained unchanged. In contrast, after TCPC, HR and RR remained stable, and systolic and diastolic blood pressure rose modestly over 48 h (p < 0.05), suggesting improved systemic perfusion and smoother hemodynamic adaptation. In the TCPC group, LVEF decreased from approximately 70% to 60% (p < 0.05) but all infants remained hemodynamically stable without need for inotropic support escalation.

Conclusion(s): Transcatheter PDA closure with the Amplatzer Piccolo™ device was not associated with the development of PLCS, more favorable hemodynamic adaptation, and only a transient physiologic reduction in LVEF. These findings indicate that device-based PDA closure is associated with a more stable hemodynamic course after the procedure than surgical ligation.

Baseline demographics
Baseline demographics of preterm infants undergoing surgical ligation (SPL) or transcatheter Piccolo device closure (TCPC). Both groups were comparable in gestational age, birth weight, sex distribution, and incidence of necrotizing enterocolitis (NEC) (p > 0.05). However, intraventricular hemorrhage (IVH) was more frequent in the TCPC group (p = 0.003), and post-ligation cardiac syndrome (PLCS) occurred exclusively in the SPL group (15% vs 0%, p = 0.02)

Left ventricular ejection fraction before and after transcatheter Piccolo device closure
Boxplot comparing pre- and post-intervention left ventricular ejection fraction (LVEF) in infants underwent transcatheter Piccolo device closure. Each box represents the interquartile range with the median line inside, and whiskers indicating the data range. Pre-intervention values are shown in light gray, and post-intervention values in dark gray.

Hemodynamic Changes Post Intervention
Line graph illustrates the trends in mean respiratory rate (RR), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) following PDA closure. In the surgical ligation group, RR and HR transiently decreased at 24-48 hours before returning toward baseline, whereas SBP and DBP remained relatively stable. In contrast, the Piccolo device group showed no significant early hemodynamic decline, with SBP demonstrating a modest rise by 48 hours (p < 0.05 vs baseline), indicating overall circulatory stability