Surgical Ligation Versus Percutaneous Closure of Patent Ductus Arteriosus in Very Low-Weight Preterm Infants: Which are the Real Benefits of the Percutaneous Approach?

Abstract

Percutaneous treatment of patent ductus arteriosus (PDA) in extreme premature infants is technically difficult, and therefore, often not consider as an alternative to surgery. The main objective of our work was to compare respiratory status prior and post ductal closure and morbi-mortality, in our series of preterm infants with percutaneous PDA closure versus surgical ligation in the same time-period. Retrospective review of all premature infants submitted to percutaneous and surgical PDA closure from January 2011 to December 2016. All the antenatal, perinatal, and postnatal characteristics were collected. The main outcome was the assessment of the pulmonary status before and after ductal closure using a pulmonary score. Secondary outcomes included moderate-severe disability in neurodevelopment, death before discharge, moderate-severe chronic lung disease, and morbidity at discharge. 25 patients with a mean weight of 1330 g (± 280) underwent percutaneous closure of PDA with ADO-II-AS, and a total of 53 underwent surgical ligation. 28/53 with similar gestational age, birth weight, and procedure weight to those in the percutaneous group, were selected to perform the comparative study. Ductal closure (percutaneous and surgical) resulted in improved respiratory status. However, percutaneous group achieved a fastest respiratory improvement, than surgical group. The surgical closure group associated higher morbidity among survivors (HIV, number of sepsis, need, and duration of inotropics post-interventionism). The incidence of recurrent laryngeal nerve palsy among the surgical group was 17%. Percutaneous closure of PDA in carefully selected low-weight preterm infants is a safe and reliable alternative to surgical ligation.

Anesthetic management of catheter‐based patent ductus arteriosus closure in neonates weighing <3 kg: A Retrospective Observational Study

“…Oversedation (especially with opioid infusions) is another potential contributing factor. It is also notable that prior research has found improved respiratory outcomes when comparing percutaneous to surgical interventions …”

Overview of transcatheter patent ductus arteriosus closure in preterm infants

“…Recent retrospective studies comparing percutaneous PDA closure versus surgical ligation showed that preterm infants with transcatheter PDA occlusion have faster improvement in respiratory function. 31,32 Patients undergoing surgical ligation at the same time period, and reportedly with similar characteristics, had higher overall morbidity including a high incidence of recurrent laryngeal nerve palsy (17%). The authors concluded that transcatheter closure of PDA in select low birth weight and preterm infants is a safe and reliable alternative to surgical ligation.…”

“…Though the transcatheter reported outcomes in preterm infants are promising, they have not been directly compared with surgical outcomes in prospective trials. Recent retrospective studies comparing percutaneous PDA closure versus surgical ligation showed that preterm infants with transcatheter PDA occlusion have faster improvement in respiratory function . Patients undergoing surgical ligation at the same time period, and reportedly with similar characteristics, had higher overall morbidity including a high incidence of recurrent laryngeal nerve palsy (17%).…”

“…Patients undergoing surgical ligation at the same time period, and reportedly with similar characteristics, had higher overall morbidity including a high incidence of recurrent laryngeal nerve palsy (17%). The authors concluded that transcatheter closure of PDA in select low birth weight and preterm infants is a safe and reliable alternative to surgical ligation …”

“…The authors concluded that transcatheter closure of PDA in select low birth weight and preterm infants is a safe and reliable alternative to surgical ligation. 32…”