Baseline characteristics
A total of 499 patients’ records from 2005 to 2018 with available datum had been reviewed. Of these, 468 were in non-severe PAH(non-SPAH) group with 154 normal pulmonary artery pressure(PAP), 314 mild-moderate PAP, and 29 were in severe PAH(SPAH) group after excluding 2 for failing to the trial occlusion. All the included PDA patients had successfully underwent transcatheter closure with Cardi-O-Fix (Starway Medical Technology, China) and Taraxaci (Shandong Visee Medical Devices Co., China).
Prior to the PSM, there were significant discrepancies between the two groups in age, height, body weight, left ventricular end diastolic (LVED), left ventricular end systolic(LVES), left atrium(LA), Aorta(AO), left ventricular eject fraction(LVEF), and PDA size (Supplementary Table 1) at its narrowest point(Table 1). Hence, we used sex, blood pressure and these above as covariates to match SPAH( severe PAH) and non-SPAH groups. After matching, 25 patients were in SPAH group, and 39 patients in non-SPAH group, without any significant difference in baseline characteristics.
Interestingly, the anatomies of PDA between the two groups were comparative no matter before or after matching, including the types of tuber, funnel and window, Meanwhile, the bi-directional shunt in SPAH group was not more prominent before and after matching.
Procedural characteristics
SPAP and mean pulmonary artery pressure (MPAP) measured by a catheter before and after occlusion in SPAH group were more higher than non-SPAH group, which was also not balanced by PSM(Table 2). For local anesthesia and occluder size, the SPAH group were more dominant before matching, but after matching, they were equivalent(Table 2).
Table 2
Procedure characteristics between SPAH and non-SPAH groups before and after propensity score matching
Characteristics
|
Before matching
|
After matching
|
SPAH
(n = 29)
|
non-SPAH
(n = 468)
|
P-value
|
SPAH
(n = 25)
|
non-SPAH
(n = 39)
|
P-value
|
General anesthesia/
local anesthesia
|
5/29
|
247/468
|
<0.001
|
4/21
|
10/29
|
0.363
|
PAPS(mmHg)
|
before operation
|
99.21 ± 24.85
|
30.34 ± 11.47
|
<0.001
|
101.95 ± 26.18
|
34.64 ± 14.2
|
<0.001
|
post operation
|
56.95 ± 19.82
|
24.16 ± 5.80
|
<0.001
|
64.28 ± 15.74
|
20.30 ± 11.01
|
<0.001
|
PAPM(mmHg)
|
before operation
|
63.73 ± 14.86
|
18.52 ± 8.53
|
<0.001
|
64.28 ± 15.74
|
20.30 ± 11.01
|
<0.001
|
post operation
|
35.68 ± 12.64
|
15.06 ± 4.11
|
<0.001
|
36.00 ± 13.65
|
14.23 ± 6.14
|
<0.001
|
LVED(mm), mean ± SD
|
52.54 ± 13.09
|
41.82 ± 10.57
|
<0.001
|
53.47 ± 13.73
|
52.25 ± 13.54
|
0.753
|
LVES(mm), mean ± SD
|
36.96 ± 11.85
|
27.74 ± 8.51
|
<0.001
|
37.77 ± 12.56
|
37.85 ± 12.62
|
0.982
|
LA(mm), mean ± SD
|
32.20 ± 9.14
|
25.26 ± 8.31
|
<0.001
|
32.67 ± 10.04
|
31.75 ± 9.70
|
0.744
|
AO(mm), mean ± SD
|
28.03 ± 7.21
|
21.17 ± 6.89
|
<0.001
|
27.45 ± 7.30
|
27.23 ± 6.44
|
0.907
|
LVEF (%), mean ± SD
|
57.79 ± 10.36
|
63.03 ± 9.01
|
0.01
|
57.55 ± 10.84
|
54.34 ± 11.49
|
0.340
|
Residual shunt,n
|
4
|
28
|
0.016
|
4
|
3
|
0.444
|
trivial shunt
|
0
|
10
|
|
0
|
1
|
|
small shunt (< 2mm)
|
2
|
14
|
|
2
|
1
|
|
large shunt (≥ 2mm)
|
2
|
4
|
|
2
|
1
|
|
PASP: pulmonary arterial systolic pressure, PAPM: mean pulmonary artery pressure, LVED : left ventricular end diastolic , |
LVES : left ventricular end systolic, LA : left atrium, AO : Aorta, LVEF: left ventricular eject fraction |
Follow-up characteristics
The median follow-up periods were 57 and 44 months for groups, respectively. There was no difference in follow-up time between the SPAH and non-SPAH groups. During this follow-up period, no any device migration, embolization, arrhythmia, hemolysis, vascular access and massive blood loss had occurred. No adverse clinical events between the two groups was detected in the short-term follow-up(less than one month), but with one death respectively between the two groups in the long-term follow-up(more than one year). No significant difference was observed in adverse clinical events between the two groups after matching(p = 0.208).
For echocardiograph examination, before matching, SPAH group was more worse than non-SPAH group no matter short- or long-term follow-up. However after matching, no significant difference between the two groups was observed, such as LVED, LVES, LA, AO and LVEF in the short- and long-term follow-up.
Before matching, RS was detected in 4 patients in the SPAH group in the short-term follow-up (2 small and 2 large), but at the last follow-up, only 1 trivial RS in the SPAH group. Meanwhile in the non-SPAH group, RS was present in 28 patients in the short-term follow-up (10 trivial, 14 small and 4 large), whereas at the last follow-up, only 2 small RS in the non-SPAH group. After matching, no discrepancy in the rate of RS was detected(Table 3).
Table 3
Follow-up characteristics between SPAH and non-SPAH groups before and after propensity score matching
Characteristics
|
Before matching
|
After matching
|
SPAH
(n = 29)
|
non-SPAH
(n = 468)
|
P-value
|
SPAH
(n = 25)
|
non-SPAH
(n = 39)
|
P-value
|
Clinical follow-up time, median (interquartile range)
|
1700(662–3028)
|
1318(836–1941)
|
0.108
|
1062(615–2707)
|
1536(901–1941)
|
0.568
|
Death, n
|
1
|
1
|
0.008
|
1
|
0
|
0.208
|
Echo follow-up time, median(interquartile range)
|
1678(784–2533)
|
924(498–1566)
|
0.003
|
1380(526–2108)
|
896(410–1550)
|
0.133
|
LVED(mm), mean ± SD
|
48.34 ± 10.93
|
40.31 ± 9.12
|
<0.001
|
48.43 ± 11.32
|
46.10 ± 10.42
|
0.44
|
LVES(mm), mean ± SD
|
32.84 ± 10.39
|
25.60 ± 6.99
|
0.001
|
33.06 ± 11.06
|
30.86 ± 9.64
|
0.419
|
LA(mm), mean ± SD
|
32.05 ± 10.82
|
26.14 ± 9.75
|
0.002
|
32.25 ± 11.69
|
29.79 ± 8.37
|
0.341
|
AO(mm), mean ± SD
|
27.75 ± 6.13
|
21.74 ± 6.64
|
<0.001
|
27.10 ± 5.84
|
26.90 ± 6.46
|
0.898
|
LVEF (%), mean ± SD
|
60.40 ± 12.21
|
66.62 ± 7.80
|
0.016
|
60.05 ± 13.24
|
62.70 ± 10.59
|
0.41
|
Residual shunt
|
1
|
2
|
<0.001
|
1
|
1
|
0.747
|
trivial shunt
|
1
|
0
|
|
1
|
1
|
|
small shunt(< 2mm)
|
0
|
2
|
|
0
|
0
|
|
large shunt (≥ 2mm)
|
0
|
0
|
|
0
|
0
|
|
Echo: echocardiography, LVED : left ventricular end diastolic ,LVES : left ventricular end systolic, |
LA : left atrium, AO : Aorta, LVEF: left ventricular eject fraction |