Is There an Optimal Timing for Surgical Ligation of Patent Ductus Arteriosus in Preterm Infants?

Vida, Vladimiro L.; Lago, Paola; Salvatori, Sabrina; Boccuzzo, Giovanna; Padalino, Massimo A.; Milanesi, Ornella; Speggiorin, Simone; Stellin, Giovanni

doi:10.1016/j.athoracsur.2008.12.101

Cited by 54 publications

(53 citation statements)

References 28 publications

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“…Most IVH (90%) occurs in the first week of life, 166 preceding the timing of surgical ligation reported in most studies. 33,45,48,50,59 Other potential key confounders include prolonged duration of mechanical ventilation, severe hypotension, postnatal sepsis, and NEC, which increase illness severity but are also associated with PDA ligation, death, NDI, CLD, and ROP. [167][168][169][170][171][172][173][174][175] These morbidities, however, can occur before, during, or after PDA treatments and thus may be considered confounders in some infants and outcomes in others.…”

Section: Figurementioning

confidence: 99%

PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks’ gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS: Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01–2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98–3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62–3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38–0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58–1.57). CONCLUSIONS: Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.

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Section: Figurementioning

confidence: 99%

PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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“…The authors of these studies recommended that early PDA ligation be performed as soon as medical treatment was unsuccessful [17,25]. In our study, the surgical closure of PDA was safe in preterm infants, and early ligation appeared to be more beneficial than late ligation.…”

Section: Surgical Ligation On Significant Patent Ductus Arteriosus Inmentioning

confidence: 52%

“…PDA is a common problem in preterm infants and has been associated with increased hospital morbidity and mortality [17]. In premature infants, PDA increased the risk of prolonged ventilation and resulted in oxygen requirements, as well as increased rates of BPD [18] and pulmonary hemorrhage [19].…”

Section: Discussionmentioning

confidence: 99%

Surgical Ligation on Significant Patent Ductus Arteriosus in Very Low Birth Weight Infants: Comparison between Early and Late Ligations

Lee

et al. 2014

Korean J Thorac Cardiovasc Surg

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Background:We aimed to evaluate the efficacy and safety of early surgical ligation (within 15 days of age) over late surgical ligation (after 15 days of age) by a comparative analysis of very low birth weight (VLBW) infants undergoing surgical correction for symptomatic patent ductus arteriosus (PDA) over the course of 6 years in our hospital. Methods: We retrospectively reviewed all the medical records in the neonatal intensive care unit at Hanyang University Seoul Hospital, from March 2007 to May 2013, to identify VLBW infants (＜1,500 g) who underwent surgical PDA ligation. Results: The gestational age (GA) in the late ligation (LL) group was significantly younger than in the early ligation (EL) group (p=0.010). The other baseline characteristics and preoperative conditions did not differ significantly between the two groups. The intubation period before surgery (p＜0.001) and the age at surgery (p＜0.001) were significantly different. The postoperative clinical outcomes of the study patients, including major morbidity and mortality, are summarized. There were no significant differences in bronchopulmonary dysplasia, sepsis, or mortality between the EL and the LL groups. However, the LL group was significantly associated with an increased risk of necrotizing enterocolitis (p=0.037) and with a prolonged duration of the total parenteral nutrition (p=0.046) after adjusting for GA. Conclusion: Early surgical ligation for the treatment of PDA that failed to close after medical treatment or in cases contraindicated for medical treatment might be desirable to reduce the incidence of necrotizing enterocolitis and to alleviate feeding intolerance in preterm infants.

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“…Vida et al (18) studied patent ductus arteriosus ligation in premature babies with the question of optimal timing for surgical ligation. There were 201 premature babies (Յ32 weeks gestation) from 2001 to 2007 who received primary medical treatment with ibuprofen.…”

Section: Cardiac Surgery/generalmentioning

confidence: 99%

The Year in Congenital Heart Disease

Graham

2010

Journal of the American College of Cardiology

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With the increasing number of excellent papers related to congenital heart disease, it has become more difficult to select those that are perceived to be particularly critical to scientific developments in the field. I have chosen in this review to focus almost entirely on results and to follow surgical-or catheterbased interventions that highlight the complex conditions that surgeons and cardiologists now are able to repair or palliate successfully. Sections chosen are tetralogy of Fallot (TOF), Fontan operation, cardiac surgery in general, transposition of the great arteries (TGA), hypoplastic left heart syndrome (HLHS), aortic valve surgery, aortoplasty, and ventricular septal defect (VSD) management. These particular areas were chosen because of the importance to the general field of congenital heart disease, and many of the areas highlighted continue to plague investigators as they attempt to improve long-term outcomes. TOFPapers about TOF include issues related to initial intervention assessment of pulmonary regurgitation (PR) timing of pulmonary valve replacement (PVR) as well as late follow-up and implication for management.Tamesberger et al.(1) reported 90 consecutive infants who underwent early repair: 25 neonates repaired due to duct-dependent pulmonary circulation or severe hypoxemia and 65 infants Ͻ4 months old with elective repair. Their results indicated no 30-day mortality, and late mortality of 2% with median follow-up of 4.7 years. Seven of 88 (8%) needed reoperation and 12 of 88 required reintervention. The younger patients did not differ significantly in intensive care unit stay, ventilator days, hospital stay, complications, or reoperation. There were more frequent transannular patches and reinterventions in the younger infants. These are excellent results, but will such early repair result in more severe PR and the need for more frequent PVR? Dohlen et al.(2) reported right ventricular outflow tract (VOT) stenting in 9 infants because of cyanosis or ductdependency and adverse risk factors. Stenting improved O 2 saturation from 73% to 94%. Median left pulmonary artery (PA) z-score increased from Ϫ4.9 to Ϫ1.5, right PA increased from Ϫ3.7 to Ϫ0.8, and Nakata index increased from 56 to 150 mm 2 /m 2 . There were no procedural complications. Six patients have undergone repair with no deaths. This is another method to palliate infants who are duct-dependent with adverse risk factors and have a pulmonary valve that is deemed unsalvageable. Stenting allows infants to obtain a greater age and size when repair theoretically is safer.Papadopoulos et al. (3) reported repair of pulmonary valves in 5 children and 2 adults. All had severe PR associated with right ventricular (RV) dilation and dysfunction after primary right VOT reconstruction. There were no operative or late deaths. All valves were repaired successfully with a mean PR grade of 1.3 post-operatively. Mean transvalvular gradient was 20 mm Hg for children and 23 mm Hg for adults. The mean RV dilation index decreased significantly from 0.85 to...

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Is There an Optimal Timing for Surgical Ligation of Patent Ductus Arteriosus in Preterm Infants?

Cited by 54 publications

References 28 publications

PDA Ligation and Health Outcomes: A Meta-analysis

PDA Ligation and Health Outcomes: A Meta-analysis

Surgical Ligation on Significant Patent Ductus Arteriosus in Very Low Birth Weight Infants: Comparison between Early and Late Ligations

The Year in Congenital Heart Disease

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