Transcatheter closure of patent ductus arteriosus demonstrates similar outcomes compared to surgical repair

1. Respiratory outcomes for preterm infants with a patent ductus arteriosus (PDA) undergoing transcatheter closure compared to surgical ligation did not differ. 

Evidence Rating Level: 2 (Good) 

Transcatheter closure of PDAs has seen increased use in recent years. However, indications and the optimal timing of this procedure as well as comparisons with traditional management options remains unclear at this time. This retrospective cohort study therefore sought to compare respiratory outcomes of PDA closure via a transcatheter approach or surgical approach in extremely preterm infants. Preterm infants with gestational age between 22 weeks and less than 29 weeks from the Neonatal Research Network’s Generic Database (NRN GDB) with a diagnosis of PDA were included in this study if they underwent transcatheter closure (n = 202, median [IQR] gestational age, 25.4 [24.1-27.1] weeks; 56% female) or surgical ligation (n = 359, median [IQR] gestational age, 24.9 [24.0-25.9] weeks; 52% female). The primary outcome was total days of mechanical ventilation with secondary outcomes including days of positive pressure ventilation and length of hospital stay. Total days of mechanical ventilation was comparable between children receiving transcatheter closure vs surgical ligation (46 [30-68] days vs 46 [21-73] days). When adjusting for several factors including center, birth year and gestational age, there were similarly no significant differences in total days of mechanical ventilation between both groups (adjusted median difference, −2.65 [95% CI, −8.36 to 3.07]; P = .36). Similarly, there were no significant differences in length of hospital stay and total days of positive pressure ventilation support. Overall, this study found that respiratory outcomes did not differ in extremely preterm infants with a PDA undergoing transcatheter closure versus surgical ligation. 

Click to read the study in JAMA Network Open

Image: PD

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