Treatment Methods for the Isolated Persistent Ductus Arteriosus in the Clinic for Paediatric Cardiology and Cardiac Surgery, Children's University Hospital Within the Last 5 Years, Taking into Consideration the Patient’s Age and Weight
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
ABSTRAKTS
Ievads un mērķi: Atvērta arteriālā vada (PDA) ārstēšana šobrīd tiek plaši apspriesta, un īpaši
priekšlaicīgi dzimušu zīdaiņu vidū pēdējo gadu laikā ir novērotas ārstēšanas izmaiņas. Tomēr
joprojām nav vienotas stratēģijas ārstēšanas metodes izvēlē priekšlaicīgi dzimušiem zīdaiņiem ar
PDA. Šī pētījuma mērķis ir salīdzināt dažādas ārstēšanas metodes, kā arī iespējamo stratēģijas
maiņu pēdējo 5 gadu laikā bērniem, kuriem tiek veikta ķirurģiska PDA slēgšana Bērnu
kardioloģijas un kardioķirurģijas klīnikā Bērnu universitātes slimnīcā, kā arī novērtēt labāko
iespējamo ārstēšanas veidu atkarībā no pacienta vecuma un svars.
Metodes: Rīgas Bērnu universitātes slimnīcas elektroniskajā datu bāzē tika apkopoti dati par
pacientiem, kuriem laikā no 2017. līdz 2021. gadam diagnosticēta un ārstēta diagnoze izolēts
atvērts arteriālais vads - manipulācijas gads, veids, kā arī pacientu vecums un svars operācijas
dienā. Kopumā apkopoti dati par 115 pacientiem, no kuriem 101 pacients tika iekļauts šajā
pētījumā. Dati tika augšupielādēti SPSS programmā, ar kuras palīdzību pacienti sadalīti dažādās
vecuma un svara grupās, un analizēta ārstēšanas metodes un operācijas veida izvēle dažādās
vecuma un svara grupās . Statistiskais nozīmīgums tika uzskatīts ar p<0,05.
Rezultāti: Pēdējos gados bija iespējams novērot būtiskas izmaiņas ārstēšanas metodes izvēlē,
samazinoties atvērta tipa operāciju skaitam, bet palielinoties slēgta tipa transvaskulārām
manipulāciju daudzumam. Īpaši jaundzimušajiem un zīdaiņiem, kas jaunāki par trīs mēnešiem,
transkatetra pieeja kļuvusi populārāka, lai gan atvērta tipa operācija joprojām tiek uzskatīta par
ieteicamāko ārstēšanas metodi lielākajai daļai jaundzimušo. Zīdaiņu grupā no viena līdz trīs
mēnešiem ķirurģiskas un transvaskulāras PDA slēgšana sastopamības biežums bija vienāds.
Visiem bērniem, kuru ķermeņa svars operācijas dienā bija vairāk par diviem kilogramiem, tika
veikta transvaskulāra PDA slēgšana, savukārt lielākajai daļai bērnu, kuru svars nepārsniedz divus
kilogramus, - ķirurģiska PDA slēgšana.
Secinājums: PDA slēgšanas ārstēšanas metodes izvēle dažos pēdējos gados ir būtiski mainījusies,
biežāk izvēloties transvazālu pieeju, īpaši jaundzimušajiem un zīdaiņiem.
Lai gan šķiet, ka tā ir labākā pašlaik pieejamā ārstēšanas metode vecākiem bērniem, mazā pacientu
skaita dēļ šobrīd vēl nav iespējams definēt labāko ārstēšanas metodi bērniem, kas jaunāki par 3
mēnešiem ar svaru mazāku par diviem kilogramiem. Ir nepieciešams veikt turpmākus pētījumus,
ņemot vērā jaunus datus, kā arī ilgtermiņa rezultātus, lai novērtētu labāko ārstēšanas metodi šajā
pacientu grupā.
ABSTRACT Background and objectives: The management of a Persistent Ductus Arteriosus is currently widely debated and especially among preterm infants, a change in treatment has been observed during the past years. However, a consensually agreed management approach for preterm infants with a PDA is still lacking. This study aims to compare the treatment method as well as a possible change in treatment approach among children undergoing surgical PDA closure in the Clinic for Paediatric Cardiology and Cardiac Surgery in the Children’s University Hospital and to evaluate the best treatment strategy depending on the patient’s age and weight. Methods: The electronical database of the Children’s University Hospital in Riga was searched for all patient’s diagnosed and treated due to an isolated Persistent Ductus Arteriosus between 2017 and 2021 and data about the year of operation, the operation type as well as the age and weight of the children at the day of operation was collected. In total 115 patients were found, out of which 101 patients were included in this study. The data was uploaded in SPSS, divided into different age and weight groups, and analysed for treatment approach as well as changes in operation method depending on the year of treatment among the different age and weight groups. Statistical significance was considered with p<0.05. Results: It was possible to observe a significant change in treatment method in the past years, away from radical and towards interventional procedures. Especially amongst neonates and infants less than three months of age, the transcatheter approach became more apparent, even though the radical operation was still the preferred treatment method in most neonates. In the group of infants between one and three months of age, the distribution of surgical ligation vs transcatheter approaches was equal. All children weighing more than two kilograms at the day of operation underwent transcatheter closure, while most children weighing less than two kilograms underwent surgical ligation, irrespective of their exact weight. Conclusion: The treatment approach to PDA closure has significantly changed in the last few years towards more interventional procedures, especially among neonates and infants. While the transcatheter approach seems to be the best treatment option currently available for older children, due to the small number of patients, it is not yet possible to determine the best treatment method for children younger than 3 months of age, weighing less than two kilograms. Future studies considering new data as well as long-term outcomes should be performed to evaluate the best treatment approach in this patient group.
ABSTRACT Background and objectives: The management of a Persistent Ductus Arteriosus is currently widely debated and especially among preterm infants, a change in treatment has been observed during the past years. However, a consensually agreed management approach for preterm infants with a PDA is still lacking. This study aims to compare the treatment method as well as a possible change in treatment approach among children undergoing surgical PDA closure in the Clinic for Paediatric Cardiology and Cardiac Surgery in the Children’s University Hospital and to evaluate the best treatment strategy depending on the patient’s age and weight. Methods: The electronical database of the Children’s University Hospital in Riga was searched for all patient’s diagnosed and treated due to an isolated Persistent Ductus Arteriosus between 2017 and 2021 and data about the year of operation, the operation type as well as the age and weight of the children at the day of operation was collected. In total 115 patients were found, out of which 101 patients were included in this study. The data was uploaded in SPSS, divided into different age and weight groups, and analysed for treatment approach as well as changes in operation method depending on the year of treatment among the different age and weight groups. Statistical significance was considered with p<0.05. Results: It was possible to observe a significant change in treatment method in the past years, away from radical and towards interventional procedures. Especially amongst neonates and infants less than three months of age, the transcatheter approach became more apparent, even though the radical operation was still the preferred treatment method in most neonates. In the group of infants between one and three months of age, the distribution of surgical ligation vs transcatheter approaches was equal. All children weighing more than two kilograms at the day of operation underwent transcatheter closure, while most children weighing less than two kilograms underwent surgical ligation, irrespective of their exact weight. Conclusion: The treatment approach to PDA closure has significantly changed in the last few years towards more interventional procedures, especially among neonates and infants. While the transcatheter approach seems to be the best treatment option currently available for older children, due to the small number of patients, it is not yet possible to determine the best treatment method for children younger than 3 months of age, weighing less than two kilograms. Future studies considering new data as well as long-term outcomes should be performed to evaluate the best treatment approach in this patient group.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
PDA, PDA, Patent Ductus Arteriosus, Persistent Ductus Arteriosus