Risk factors for intraoperative hemorrhage and perioperative complications and short- and long-term outcomes during surgical patent ductus arteriosus ligation in 417 dogs

Kaitlyn L. McNamara Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL

Search for other papers by Kaitlyn L. McNamara in
Current site
Google Scholar
PubMed Close
 DVM, MS
,
Penny J. Regier Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL

Search for other papers by Penny J. Regier in
Current site
Google Scholar
PubMed Close
 DVM, MS, DACVS
,
Darby Toth Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL

Search for other papers by Darby Toth in
Current site
Google Scholar
PubMed Close
 DVM
,
Megan Mickelson Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA

Search for other papers by Megan Mickelson in
Current site
Google Scholar
PubMed Close
 DVM, DACVS
,
Jill Luther Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO

Search for other papers by Jill Luther in
Current site
Google Scholar
PubMed Close
 DVM, MS, DACVS
,
Connor Pyne Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO

Search for other papers by Connor Pyne in
Current site
Google Scholar
PubMed Close
 DVM
,
Mandy Wallace Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Mandy Wallace in
Current site
Google Scholar
PubMed Close
 DVM, MS, DACVS
,
Charlee Sturkie Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Charlee Sturkie in
Current site
Google Scholar
PubMed Close
 BS
,
Danielle Dugat Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK

Search for other papers by Danielle Dugat in
Current site
Google Scholar
PubMed Close
 DVM, MS, DACVS
,
Sarah Marvel Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO

Search for other papers by Sarah Marvel in
Current site
Google Scholar
PubMed Close
 DVM, MS, DACVS
,
Julia Sumner Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY

Search for other papers by Julia Sumner in
Current site
Google Scholar
PubMed Close
 BVSc, DACVS
,
Val Scharf Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

Search for other papers by Val Scharf in
Current site
Google Scholar
PubMed Close
 DVM, MS, DACVS
,
Jory Clark Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

Search for other papers by Jory Clark in
Current site
Google Scholar
PubMed Close
 DVM
, and
James C. Colee Statistical Consulting Unit, Institute of Farm and Agricultural Sciences, University of Florida, Gainesville, FL

Search for other papers by James C. Colee in
Current site
Google Scholar
PubMed Close
 MS
DOI:
https://doi.org/10.2460/javma.22.12.0541
Volume/Issue:
Volume 261: Issue 8
Online Publication Date:
28 Mar 2023
Restricted access
Sign In Reprints and Permissions Purchase Article

Abstract

OBJECTIVE

To evaluate the short- and long-term outcomes of dogs undergoing surgical ligation for a left-to-right shunting patent ductus arteriosus (PDA), identify risk factors for intraoperative hemorrhage and intra- and postoperative complications, and report overall mortality rates.

ANIMALS

417 client-owned dogs undergoing surgical ligation for a left-to-right shunting PDA between January 2010 and January 2020.

PROCEDURES

Data recorded included patient signalment, echocardiogram findings, intraoperative complications and mortality, postoperative complications, and short- and long-term outcomes.

RESULTS

There was no association between age and risk of intraoperative hemorrhage (P = .7), weight and intraoperative hemorrhage (P = .96), or increasing left atrium-to-aortic (LA:Ao) ratio and intraoperative hemorrhage (P = .08). Intraoperative hemorrhage occurred in 10.8% of patients. Intraoperative mortality was 2%. Ninety-five percent of dogs experiencing intraoperative hemorrhage survived to discharge. Survival to discharge was 97%. One- and 5-year survival rates were 96.4% and 87%, respectively.

CLINICAL RELEVANCE

Surgical ligation for a left-to-right shunting PDA is recommended due to the good long-term prognosis. Certain preoperative factors such as age, weight, and the presence and degree of mitral valve regurgitation had no detectable association with risks of intraoperative hemorrhage and, therefore, should not preclude surgical treatment for a left-to-right shunting PDA. Future studies are needed to further assess the association between increasing LA:Ao ratio and risk of intraoperative hemorrhage.

Abstract

OBJECTIVE

To evaluate the short- and long-term outcomes of dogs undergoing surgical ligation for a left-to-right shunting patent ductus arteriosus (PDA), identify risk factors for intraoperative hemorrhage and intra- and postoperative complications, and report overall mortality rates.

ANIMALS

417 client-owned dogs undergoing surgical ligation for a left-to-right shunting PDA between January 2010 and January 2020.

PROCEDURES

Data recorded included patient signalment, echocardiogram findings, intraoperative complications and mortality, postoperative complications, and short- and long-term outcomes.

RESULTS

There was no association between age and risk of intraoperative hemorrhage (P = .7), weight and intraoperative hemorrhage (P = .96), or increasing left atrium-to-aortic (LA:Ao) ratio and intraoperative hemorrhage (P = .08). Intraoperative hemorrhage occurred in 10.8% of patients. Intraoperative mortality was 2%. Ninety-five percent of dogs experiencing intraoperative hemorrhage survived to discharge. Survival to discharge was 97%. One- and 5-year survival rates were 96.4% and 87%, respectively.

CLINICAL RELEVANCE

Surgical ligation for a left-to-right shunting PDA is recommended due to the good long-term prognosis. Certain preoperative factors such as age, weight, and the presence and degree of mitral valve regurgitation had no detectable association with risks of intraoperative hemorrhage and, therefore, should not preclude surgical treatment for a left-to-right shunting PDA. Future studies are needed to further assess the association between increasing LA:Ao ratio and risk of intraoperative hemorrhage.

Contributor Notes

Corresponding author: Dr. Regier (pregier@ufl.edu)
Cover Journal of the American Veterinary Medical Association
Journal of the American Veterinary Medical Association
Publication Date:
01 Aug 2023
  • 1.

    Broaddus K, Tillson M. Patent ductus arteriosus in dogs. Compend Contin Educ Vet. 2010;32(9):E3.

  • 2.

    Bascuñán A, Thieman Mankin KM, Saunders AB, et al. Patent ductus arteriosus in cats (Felis catus): 50 cases (2000-2015). J Vet Cardiol. 2017;19(1):35–43.

    • Search Google Scholar
    • Export Citation
  • 3.

    Saunders AB, Gordon SG, Boggess MM, Miller MW. Long-term outcome in dogs with patent ductus arteriosus: 520 cases (1994-2009). J Vet Intern Med. 2014;28(2):401–410.

    • Search Google Scholar
    • Export Citation
  • 4.

    Greet V, Bode EF, Dukes-McEwan J, Oliveira P, Connolly DJ, Sargent J. Clinical features and outcome of dogs and cats with bidirectional and continuous right-to-left shunting patent ductus arteriosus. J Vet Intern Med. 2021;35(2):780–788.

    • Search Google Scholar
    • Export Citation
  • 5.

    Grimes JA, Thieman Mankin KM. Surgical ligation of patent ductus arteriosus in dogs: incidence and risk factors for rupture. Vet Surg. 2022;51(4):592–599.

    • Search Google Scholar
    • Export Citation
  • 6.

    Hunt GB, Simpson DJ, Beck JA, et al. Intraoperative hemorrhage during patent ductus arteriosus ligation in dogs. Vet Surg. 2001;30(1):58–63.

  • 7.

    Bureau S, Monnet E, Orton EC. Evaluation of survival rate and prognostic indicators for surgical treatment of left-to-right patent ductus arteriosus in dogs: 52 cases (1995-2003). J Am Vet Med Assoc. 2005;227(11):1794–1799.

    • Search Google Scholar
    • Export Citation
  • 8.

    Goodrich KR, Kyles AE, Kass PH, Campbell F. Retrospective comparison of surgical ligation and transarterial catheter occlusion for treatment of patent ductus arteriosus in two hundred and four dogs (1993-2003). Vet Surg. 2007;36(1):43–49.

    • Search Google Scholar
    • Export Citation
  • 9.

    Hansson K, Häggström J, Kvart C, Lord P. Left atrial to aortic root indices using two-dimensional and M-mode echocardiography in cavalier King Charles Spaniels with and without left atrial enlargement. Vet Radiol Ultrasound. 2002;43(6):568–575.

    • Search Google Scholar
    • Export Citation
  • 10.

    Marchesotti F, Vezzosi T, Tognetti R, et al. Left atrial anteroposterior diameter in dogs: reference interval, allometric scaling, and agreement with the left atrial-to-aortic root ratio. J Vet Med Sci. 2019;81(11):1655–1662.

    • Search Google Scholar
    • Export Citation
  • 11.

    Singh MK, Kittleson MD, Kass PH, Griffiths LG. Occlusion devices and approaches in canine patent ductus arteriosus: comparison of outcomes. J Vet Intern Med. 2012;26(1):85–92.

    • Search Google Scholar
    • Export Citation
  • 12.

    Houghton HE, Ware WA. Patent ductus arteriosus in dogs. Iowa State Univ Vet. 1996;58(2):13.

  • 13.

    Achen SE, Miller MW, Gordon SG, Saunders AB, Roland RM, Drourr LT. Transarterial ductal occlusion with the Amplatzer vascular plug in 31 dogs. J Vet Intern Med. 2008;22(6):1348–1352.

    • Search Google Scholar
    • Export Citation
  • 14.

    Van Israël N, French AT, Dukes-McEwan J, Corcoran BM. Review of left-to-right shunting patent ductus arteriosus and short term outcome in 98 dogs. J Small Anim Pract. 2002;43(9):395–400.

    • Search Google Scholar
    • Export Citation
  • 15.

    Eyster GE, Eyster JT, Cords GB, Johnston J. Patent ductus arteriosus in the dog: characteristics of occurrence and results of surgery in one hundred consecutive cases. J Am Vet Med Assoc. 1976;168(5):435–438.

    • Search Google Scholar
    • Export Citation
  • 16.

    Cocciolone AJ, Hawes JZ, Staiculescu MC, Johnson EO, Murshed M, Wagenseil JE. Elastin, arterial mechanics, and cardiovascular disease. Am J Physiol Heart Circ Physiol. 2018;315(2):H189–H205.

    • Search Google Scholar
    • Export Citation
  • 17.

    Birchard SJ, Bonagura JD, Fingland RB. Results of ligation of patent ductus arteriosus in dogs: 201 cases (1969-1988). J Am Vet Med Assoc. 1990;196(12):2011–2013.

    • Search Google Scholar
    • Export Citation

Advertisement