Osawa Takumi, Takahara Mistuyoshi, Shinke Toshiro, Kohsaka Shun, Hoshi Tomoya, Saji Mike, Hara Hidehiko, Amano Testuya, Kawamatsu Naoto, Machino-Ohtsuka Tomoko, Ishizu Tomoko, Kozuma Ken
Department of Cardiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Cardiovasc Interv Ther. 2025 Aug 11. doi: 10.1007/s12928-025-01174-x.
Large-scale data on the current status, outcomes, and complications of transcatheter patent ductus arteriosus (PDA) closure in adults remain limited. This study aimed to elucidate the current status of transcatheter PDA closure in adults. Patient data (age ≥ 16 years) between January 2015 and December 2023 were extracted from the Japanese Structural Heart Disease (J-SHD) registry. We assessed the current practice of transcatheter PDA closure in Japan, focusing on the clinical characteristics, in-hospital mortality, intraoperative deaths, and adverse events. Procedural success was defined as appropriate device implantation without any adverse events. A total of 377 adult patients (median age, 65 years [interquartile range, 50-74 years]; 18.3% male) who underwent transcatheter PDA closure were included. Overall, 9.8% (n = 24) of the patients were New York Heart Association class III/IV. The most common comorbidities were hypertension (43.0%, n = 162), hyperlipidemia (16.7%, n = 63), and renal dysfunction (10.9%, n = 41). The median Qp/Qs ratio was 1.5 [1.3-1.8], and the median procedural time was 100 [65-120] minutes. The procedural success rate was 99.2% (n = 374). The rate of failed deployment was 0.3% (n = 1). No intraoperative deaths occurred, and complications were rare; 0.5% (n = 2) of the patients required emergency surgery. No hemorrhage requiring transfusion, vascular rupture, vessel obstruction, or contrast-induced nephropathy was observed after the procedures. Real-world data demonstrated that transcatheter PDA closure is safe and effective in adults. However, the high prevalence of comorbidities and the rare occurrence of emergency surgery underscore the need for careful postprocedural management.
关于成人经导管动脉导管未闭（PDA）封堵术的现状、结局和并发症的大规模数据仍然有限。本研究旨在阐明成人经导管PDA封堵术的现状。从日本结构性心脏病（J-SHD）登记处提取了2015年1月至2023年12月期间的患者数据（年龄≥16岁）。我们评估了日本经导管PDA封堵术的当前实践，重点关注临床特征、院内死亡率、术中死亡和不良事件。手术成功定义为成功植入合适装置且无任何不良事件。共有377例接受经导管PDA封堵术的成年患者（中位年龄65岁[四分位间距，50 - 74岁]；男性占18.3%）纳入研究。总体而言，9.8%（n = 24）的患者为纽约心脏协会III/IV级。最常见的合并症是高血压（43.0%，n = 162）、高脂血症（16.7%，n = 63）和肾功能不全（10.9%，n = 41）。中位Qp/Qs比值为1.5[1.3 - 1.8]，中位手术时间为100[65 - 120]分钟。手术成功率为99.2%（n = 374）。封堵失败率为0.3%（n = 1）。无术中死亡发生，并发症罕见；0.5%（n = 2）的患者需要急诊手术。术后未观察到需要输血的出血、血管破裂、血管阻塞或造影剂肾病。真实世界数据表明，经导管PDA封堵术在成人中是安全有效的。然而，合并症的高患病率和急诊手术的罕见发生凸显了术后仔细管理的必要性。
