Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children’s Hospitals

Abstract

Background 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. We hypothesized that patients undergoing TC have improved outcomes compared with SL, including mortality, hospital and intensive care unit length of stay, and mechanical ventilation. Methods and Results 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. Conclusions TC is associated with lower mortality and reduced length of stay compared with SL. Rates of TC continue to increase compared with SL.

Transcatheter Closure vs. Surgical Ligation in Preterm Infants with Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis

“…1A). Similarly, necrotising enterocolitis (NEC) was reported in 5 studies [14,15,19,27,28] and our study illustrated a comparable baseline characteristic between the TC (n = 31, 13.6%) and SL cohorts (n = 30, 11.6%) (OR = 1.22, 95% CI: 0.20, 7.33, I 2 = 80%) (Fig. 1B).…”

“…1B). Additionally, 5 studies [14,15,18,27,28] reported intraventricular haemorrhage (IVH) as a pre-procedural comorbidity, demonstrating no difference between the TC group (n = 24, 12.7%) and the SL group (n = 58, 21.7%) (OR = 0.63, 95% CI: 0.21, 1.86, I 2 = 60%) (Fig. 1C).…”

“…Finally, 8 studies (n = 756) met the eligibility criteria and were included. 3 of the studies [14,15,19] were conducted at multicentre facilities. All the included studies were retrospective.…”

“…All 8 studies reported patient comorbidities in both groups (TC: n = 366, SL: n = 390) prior to the procedure. 2 studies [14,28] reported bronchopulmonary dysplasia (BPD) as a pre-procedural comorbidity, with the data showing no difference between the TC group (n = 60, 51.7%) and the SL group (n = 59, 48.4%) (OR = 1.21, 95% CI: 0.71, 2.08, I 2 = 0%) (Fig. 1A).…”

“…Furthermore, advancements in the procedure have resulted in successful closure in premature infants as small as 700 g [12,13]. In comparing SL and TC, recent studies support that TC is associated with reduced mortality and length of hospital stay [14], while providing equivalent efficiency and safety [15,16]. Furthermore, previous literature demonstrated infants who underwent TC had earlier recoveries and less need for short-term respiratory support [17][18][19][20].…”