Hostname: page-component-669899f699-tzmfd Total loading time: 0 Render date: 2025-04-25T19:11:47.779Z Has data issue: false hasContentIssue false
  • English
  • Français

Percutaneous closure of patent ductus arteriosus versus surgical treatment in low-birth-weight preterms: a systematic review and meta-analysis

Published online by Cambridge University Press:  08 February 2024

Camila Dos Santos Melchior Open the ORCID record for Camila Dos Santos Melchior [Opens in a new window] ,
Gabriel Rezende Neves ,
Bruna Letícia de Oliveira ,
Ana Carolina Toguchi ,
Jesana Costa Lopes ,
Marcos Alves Pavione  and
Shirley Katherine Tinajero Enríquez
Camila Dos Santos Melchior*
Affiliation:
Universidade Iguaçu, Rio de Janeiro, Brazil
Gabriel Rezende Neves
Affiliation:
Universidade do Estado do Pará, Pará, Brazil
Bruna Letícia de Oliveira
Affiliation:
Centro Universitário Católico Salesiano Auxilium Araçatuba, São Paulo, Brazil
Ana Carolina Toguchi
Affiliation:
Centro Universitário São Camilo, São Paulo, Brazil
Jesana Costa Lopes
Affiliation:
Universidade Federal do Tocantins, Tocantins, Brazil
Marcos Alves Pavione
Affiliation:
Universidade Tiradentes, Sergipe, Brazil
Shirley Katherine Tinajero Enríquez
Affiliation:
Hospital de Especialidades Santa Margarita, Portoviejo, Ecuador
*
Corresponding author: Camila dos Santos Melchior; Email: melchior.md@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The optimal management of a patent ductus arteriosus in a population of preterm infants is controversial. Traditionally, when the patent ductus arteriosus does not close either with conservative treatment or in response to pharmacological therapy, the only option is surgical closure. However, transcatheter occlusion might provide a therapeutic alternative.

Methods:

We searched PubMed, Embase, and Cochrane databases for non-randomised and randomised controlled trials that compared transcatheter percutaneous closure of patent ductus arteriosus with surgical ligation in low-birth-weight preterm infants (<2,500 g). A random-effects model was used for outcomes with high heterogeneity.

Results:

We included twelve studies comprising 4,668 low-birth-weight preterm infants, of whom 966 (20.7%) were in the transcatheter percutaneous closure group, and 3,702 (79.3%) patients were included in the surgical group. All-cause mortality (OR 0.28; 95% confidence interval 0.18–0.423; p < 0.00001; I2 = 0%) and haemodynamic instability (OR 0.10; 95% confidence interval 0.05–0.21; p < 0.001; I2 = 14%) were significantly lower in the transcatheter percutaneous closure group. There was no significant difference between transcatheter and surgical patent ductus arteriosus closure for the outcomes of bronchopulmonary dysplasia (0.93; 95% confidence interval 0.46–1.87; p = 0.83; I2 = 0%) and major complications (OR 0.76; 95% confidence interval 0.34–1.69; p = 0.51; I2 = 43%).

Conclusion:

These findings suggest that transcatheter patent ductus arteriosus closure in preterm infants under 2,500 g is a safe and effective alternative to surgical treatment. There was a substantial reduction in all-cause mortality and haemodynamic instability with transcatheter intervention compared to surgical closure.

Keywords

Pretermsurgical ligationtranscatheter percutaneous closurepatent ductus arteriosuslow birth weight
Type
Review
Information
Cardiology in the Young , Volume 34 , Issue 4 , April 2024 , pp. 705 - 712
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Backes, CH, Hill, KD, Shelton, EL, et al. Patent ductus arteriosus: a contemporary perspective for the pediatric and adult cardiac care provider. J Am Heart Assoc 2022; 11: e025784.CrossRefGoogle ScholarPubMed
Mallick, B, Nayak, SR, Tripathy, SK. The study of clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA. Int J Basic Clin Pharmacol 2018; 7: 1593.CrossRefGoogle Scholar
Parkerson, S, Philip, R, Talati, A, Sathanandam, S. Management of patent ductus arteriosus in premature infants in 2020. Front Pediatr 2021; 8: 590578.CrossRefGoogle ScholarPubMed
Dice, JE, Bhatia, J. Patent ductus arteriosus: an overview. J Pediatr Pharmacol Therap 2007; 12: 138–146.Google ScholarPubMed
Weisz, DE, More, K, McNamara, PJ, Shah, PS. PDA ligation and health outcomes: a meta-analysis. Pediatrics 2014; 133: e1024–46. DOI: 10.1542/peds.2013-3431.CrossRefGoogle ScholarPubMed
Janz-Robinson, EM, Badawi, N, Walker, K, Bajuk, B, Abdel-Latif, ME. Neonatal intensive care unit network. Neurodevelopmental outcomes of premature infants treated for patent ductus arteriosus: a population-based cohort study. J Pediatr 2015; 167: 1025–1032.CrossRefGoogle ScholarPubMed
Drighil, A, Jufan, MA, Omrane, KA, et al. Safety of transcatheter patent ductus arteriosus closure in small weight infants. J Interv Cardiol, 2012; 25: 391–394. DOI: 10.1111/j.1540-8183.2012.00733.x.CrossRefGoogle ScholarPubMed
Wang, J-N, Lin, Y-C, Hsieh, M-L, Wei, Y-J, Ju, Y-T, Wu, J-M. Transcatheter closure of patent ductus arteriosus in premature infants with very low birth weight. Front Pediatr 2021; 8: 615919.CrossRefGoogle ScholarPubMed
Sterne, JA, Hernán, MA, Reeves, BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919.CrossRefGoogle ScholarPubMed
Lenoir, M, Wanert, C, Bonnet, D, et al. Anterior minithoracotomy vs. transcatheter closure of patent ductus arteriosus in very preterm infants. Front Pediatr 2021; 9: 700284. DOI: 10.3389/fped.2021.700284.CrossRefGoogle ScholarPubMed
McLean, K, Raff, G, Lakshminrushimha, S, et al. Outcomes of PDA management in VLBW infants: transcatheter closure vs. surgical ligation. Catheter Cardiovasc Interv 2022: 17. DOI: 10.1002/ccd.28864.Google Scholar
Pamukcu, O, Tuncay, A, Narin, N, et al. Patent ductus arteriosus closure in preterms less than 2 kg: surgery versus transcatheter. Int J Cardiol 2018; 250: 110–115.CrossRefGoogle ScholarPubMed
Rauser, T, Marshall, A, Agrawal, P, et al. editors. Outcomes of ligation versus catheter occlusion in very low birthweight infants. J Investig Med 2019: 150. DOI: 10.1136/jim-2019-WMRC.346.Google Scholar
Sathanandam, S, Balduf, K, Chilakala, S, et al. Role of transcatheter patent ductus arteriosus closure in extremely low birth weight infants. Catheter Cardiovasc Interv 2019; 93: 89–96. DOI: 10.1002/ccd.27808.CrossRefGoogle ScholarPubMed
Serrano, RM, Madison, M, Lorant, D, et al. Comparison of post-patent ductus arteriosus ligation syndrome in premature infants after surgical ligation vs. percutaneous closure. J Perinatol 2020; 40: 324–329.CrossRefGoogle ScholarPubMed
Tabb, C, Aggarwal, S, Bajaj, M, Natarajan, G. Comparative effectiveness of surgical ligation and catheter closure of patent ductus arteriosus in preterm infants. Pediatr Cardiol 2023. DOI: 10.1007/s00246-023-03199-6.CrossRefGoogle ScholarPubMed
Philip, R, Waller, B, Chilakala, S, et al. Comparison of low cardiac output syndrome after pda ligation and transcatheter pda closure in extremely low birth weight infants. J Am Coll Cardiol 2019; 73: 575. DOI: 10.1016/S0735-1097(19)31183-0.CrossRefGoogle Scholar
Giesinger, RE, Bischoff, AR, McNamara, PJ. Anticipatory perioperative management for patent ductus arteriosus surgery: understanding post ligation cardiac syndrome. Congenit Heart Dis 2019; 14: 311–316.CrossRefGoogle Scholar
Lee, JA. Practice for preterm patent ductus arteriosus; focusing on the hemodynamic significance and the impact on the neonatal outcomes. Korean J Pediatr 2019; 62: 245–251.CrossRefGoogle ScholarPubMed
McNamara, PJ, Sehgal, A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Childh Fetal Neonat Ed 2007; 92: F424–427.CrossRefGoogle ScholarPubMed
Mitra, S, Scrivens, A, Von Kursell, AM, Disher, T. Early treatment versus expectant management of hemodynamically significant patent ductus arteriosus for preterm infants. Cochrane Datab Syst Rev 2020; 12: CD013278.Google ScholarPubMed
Sathanandam, S, Gutfinger, D, Morray, B, et al. Consensus guidelines for the prevention and management of periprocedural complications of transcatheter patent ductus arteriosus closure with the amplatzer piccolo occluder in extremely low birth weight infants. Pediatr Cardiol 2021; 42: 1258–1274.CrossRefGoogle ScholarPubMed
Bischoff, AR, Kennedy, KF, Backes, CH, et al. Percutaneous closure of the patent ductus arteriosus in infants ≤2 kg: IMPACT registry insights. Pediatrics 2023; 152: e2023061460. DOI: 10.1542/peds.2023-061460.CrossRefGoogle Scholar
Regan, W, Benbrik, N, Sharma, S, et al. Improved ventilation in premature babies after transcatheter versus surgical closure of patent ductus arteriosus. Int J Cardiol 2020; 311: 22–27. DOI: 10.1016/j.ijcard.2020.03.040.CrossRefGoogle ScholarPubMed
Barry, OM, Gudausky, TM, Balzer, DT, et al. Safety and short-term outcomes for infants <2.5 kg undergoing PDA device closure: a C3PO registry study. Pediatr Cardiol 2023; 44: 1406–1413. DOI: 10.1007/s00246-023-03147-4.CrossRefGoogle ScholarPubMed
Wei, Y-J, Chen, Y-J, Lin, Y-C, et al. Respiratory trajectory after invasive interventions for patent ductus arteriosus of preterm infants. Children 2021; 8: 398. DOI: 10.3390/children8050398.CrossRefGoogle ScholarPubMed
Doshi, H, Bhatt, P, & Ampem-Darko, C, et al. Outcomes of ligation versus catheter occlusion in very low birthweight infants. J Investig Med 2019: 150. DOI: 10.1136/jim-2019-WMRC.346.Google Scholar
Lefort, B, Duboué, PM, Martin, F, et al. Percutaneous closure of very low weight preterm new-borns ductus arteriosus prevents post ligature cardiac syndrome and reduces all-cause mortality compared to surgery. Archiv Cardiovasc Dis Suppl 2022; 14: 1878–6480.Google Scholar
Rodríguez Ogando, A, Planelles Asensio, I, de la Blanca, ARS, et al. Surgical ligation versus percutaneous closure of patent ductus arteriosus in very low-weight preterm infants: which are the real benefits of the percutaneous approach? Pediatr Cardiol 2018; 39: 398–410.CrossRefGoogle ScholarPubMed
Philip, R, Waller, B, Chilakala, S, et al. Comparison of low cardiac output syndrome after PDA ligation and transcatheter PDA closure in extremely low birth weight infants. J Am Coll Cardiol 2019; 73: 575. DOI: 10.1016/S0735-1097(19)31183-0.CrossRefGoogle Scholar
Supplementary material: File

Melchior et al. supplementary material

Melchior et al. supplementary material
Download Melchior et al. supplementary material(File)
File 37 KB