In neonates & infants, Transcatheter PDA closure is better than surgery, according to a recent study published in the Journal of the American Heart Association.
Pharmacologic therapy for patent ductus arteriosus closure is not consistently successful. Surgical ligation (SL) or transcatheter closure (TC) may be needed. Large multicenter analyses comparing outcomes and resource use between SL and TC are lacking. A group of researchers hypothesized that patients undergoing TC have improved outcomes compared with SL, including mortality, hospital and intensive care unit length of stay, and mechanical ventilation.
Using the 2016 to 2020 Pediatric Health Information System database, characteristics, outcomes, and charges of patients aged <1 year who underwent TC or SL were analyzed. A total of 678 inpatients undergoing TC (n=503) or SL (n=175) were identified. Surgical patients were younger (0.1 versus 0.53 years; P<0.001) and more premature (60% versus 20.3%; P<0.001). Surgical patients had higher mortality (1.7% versus 0%; P=0.02). Using inverse probability of treatment weighting by the propensity score, multivariable‐adjusted analyses demonstrated favorable outcomes in TC: intensive care unit admission rates (adjusted odds ratio [OR], 0.2; 95% CI, 0.11–0.32; P<0.001); mechanical ventilation rates (adjusted OR, 0.3; 95% CI, 0.19–0.56; P<0.001); and shorter hospital (adjusted coefficient, 2 days shorter; 95% CI, 1.3–2.7; P<0.001) and postoperative (adjusted coefficient, 1.2 days shorter; 95% CI, 0.1–2.3; P=0.039) stays. Overall charges and readmission rates were similar. Among premature neonates and infants, hospital (adjusted difference in medians, 4 days; 95% CI, 1.7–6.3 days; P<0.001) and postoperative stays (adjusted difference in medians, 3 days; 95% CI, 1.1–4.9 days; P=0.002) were longer for SL.
Thus, transcatheter closure is associated with lower mortality and reduced length of stay compared with Surgical ligation. Rates of TC continue to increase compared with SL.
Reference:
Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children's Hospitals by Michael T. Kuntz, et al. published in the Journal of the American Heart Association.
https://www.ahajournals.org/doi/10.1161/JAHA.121.022776