Cardiac remodeling in adults following percutaneous PDA closure: A meta-analysis

Abstract

Structured Abstract Background While percutaneous closure is preferred in adults with a patent ductus arteriosus (PDA), the extent of cardiac remodeling following percutaneous PDA closure in adults is not well understood. We performed a meta-analysis to characterize cardiac remodeling following percutaneous PDA closure in adults. Methods MEDLINE and EMBASE were systematically searched for original studies that reported echocardiographic variables at baseline, immediately post-procedure (24 hours), and at follow-up (>1 month) in adults undergoing percutaneous PDA closure. Additionally, we included data from patients >18 years of age that underwent percutaneous PDA closure between January 2015-December 2019 at our centre. Weighted averages were calculated for parameters with sufficient data. Pooled differences were presented as weighted mean differences (WMD). Results After screening 278 abstracts, 5 studies were identified. When combined with our cohort, our meta-analysis encompassed 244 patients. Immediately post-procedure, LVEF was the only parameter to change significantly (64 vs 52%, WMD -8.64 95% CI -14.04 to -3.25). All parameters significantly decreased from baseline to follow-up: LVEF: 64 vs 60 % (WMD -3.95, CI -5.80 to -2.09), LVEDD: 62 vs 53 mm (WMD -8.79 CI -12.78 to -4.81) LVEDVI 172 vs 123 mL/m2 (WMD -26.60, CI -45.4 to -7.85), LVESD 42 vs 36 mm (WMD -4.64, CI -9.10 to -0.17) and LA dimension: 42 vs 37 mm (WMD -5.87, CI -9.85 to -1.90). Conclusions As compared to the baseline values, left ventricular and left atrial sizes decreased. The LVEF decreased immediately following PDA closure and, while it recovers, it remained lower on follow-up testing.