Catheterization Therapy vs Surgical Closure in Pediatric Patients With Patent Ductus Arteriosus: A Meta‐Analysis

Abstract

Background: Patent ductus arteriosus (PDA) remains a common congenital heart disease in pediatric patients, and the new trend of catheterization therapy is still associated with some potential risks and complications. Hypothesis: Compared with surgical closure, the clinical effect of catheterization therapy in pediatric PDA patients requires meta-analysis. Methods: A systematic literature search of PubMed, Cochrane Library, Embase, Science Citation Index, Web of Science, and the Chinese Biomedicine literature database was conducted. Eligible studies included controlled trials of pediatric PDA patients receiving catheterization therapy vs surgical closure. Relative risks (RRs), standard mean differences, and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I 2 test. Results: Seven studies with a total of 810 patients met the inclusion criteria. Catheterization therapy neither significantly increased the primary success rate (RR: 0.92, 95% CI: 0.82-1.03, P = 0.16) nor reduced the total postprocedure complications (RR: 0.74, 95% CI: 0.44-1.25, P = 0.26) and blood transfusion (RR: 1.10, 95% CI: 0.16-7.67, P = 0.93). Catheterization was associated with a statistically significant increase in residual shunts (RR: 5.19,, P = 0.01) and reduction in length of hospital stay (standard mean difference: −1.66, 95% CI: −2.65 to −0.67, P = 0.001). Conclusions: Catheterization therapy in pediatric PDA patients did not show a significant advantage in primary success rate, total complications, or blood transfusion, but it was associated with increase in residual shunts and reduction in length of hospital stay.

Pattern of Congenital Heart Diseases and Treatment Options in a Bangladeshi Centre: Analysis of 6914 cases from Non-invasive Cardiac Laboratory

“…A Meta analysis showed no significant cost advantage in primary success rate, total complications or rate of blood transfusion in device and surgery group. 21 In our series device group had almost no complications and success rate was 100% in attempted patient.…”

Surgical closure of patent ductus arteriosus in extremely low birth weight infants weighing less than 750 grams

“…However, catheter-based therapy was shown to be associated with an increase in residual shunt. Moreover, there are some absolute contraindications for catheter closure, such as a large ductal diameter, very small weight of a preterm, infection, unfavourable clinical condition, or calcification of the duct [6,11]. Our clinical observational study involves only critically ill extremely LBW infants with birth weight less than 750 g. Thus, due to the anatomical conditions and preoperative state, all patients were qualified for surgical ligation.…”

“…Recent studies report a higher rate of complications after surgical ligation [2][3][4][5] that resulted in the shift from aggressive approach to conservative or pharmacological treatment. However, if they fail and the percutaneous therapy is contraindicated, surgical intervention remains the only solution [6,7].…”

What Interventional Cardiologists Are Still Leaving to the Surgeons?

“…Patent ductus arteriosus is one of the most common CHDs in all ages. Since the first report of transcatheter closure 50 years ago, currently, transcatheter PDA closure has become a widely accepted procedure worldwide with comparable results to surgical therapy ( 20 , 21 ). Major adverse events of transcatheter PDA occlusion (i.e., device embolization, hemolysis, and obstruction of the left pulmonary artery/aortic isthmus) can occur with incidence of 0.6–83.3% depending upon the selected device ( 18 , 19 ).…”