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Percutaneous closure of patent ductus arteriosus versus surgical treatment in low-birth-weight preterms: a systematic review and meta-analysis

Published online by Cambridge University Press:  08 February 2024

Camila Dos Santos Melchior Open the ORCID record for Camila Dos Santos Melchior [Opens in a new window] ,
Gabriel Rezende Neves ,
Bruna Letícia de Oliveira ,
Ana Carolina Toguchi ,
Jesana Costa Lopes ,
Marcos Alves Pavione  and
Shirley Katherine Tinajero Enríquez
Camila Dos Santos Melchior*
Affiliation:
Universidade Iguaçu, Rio de Janeiro, Brazil
Gabriel Rezende Neves
Affiliation:
Universidade do Estado do Pará, Pará, Brazil
Bruna Letícia de Oliveira
Affiliation:
Centro Universitário Católico Salesiano Auxilium Araçatuba, São Paulo, Brazil
Ana Carolina Toguchi
Affiliation:
Centro Universitário São Camilo, São Paulo, Brazil
Jesana Costa Lopes
Affiliation:
Universidade Federal do Tocantins, Tocantins, Brazil
Marcos Alves Pavione
Affiliation:
Universidade Tiradentes, Sergipe, Brazil
Shirley Katherine Tinajero Enríquez
Affiliation:
Hospital de Especialidades Santa Margarita, Portoviejo, Ecuador
*
Corresponding author: Camila dos Santos Melchior; Email: melchior.md@hotmail.com
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Abstract

Introduction:

The optimal management of a patent ductus arteriosus in a population of preterm infants is controversial. Traditionally, when the patent ductus arteriosus does not close either with conservative treatment or in response to pharmacological therapy, the only option is surgical closure. However, transcatheter occlusion might provide a therapeutic alternative.

Methods:

We searched PubMed, Embase, and Cochrane databases for non-randomised and randomised controlled trials that compared transcatheter percutaneous closure of patent ductus arteriosus with surgical ligation in low-birth-weight preterm infants (<2,500 g). A random-effects model was used for outcomes with high heterogeneity.

Results:

We included twelve studies comprising 4,668 low-birth-weight preterm infants, of whom 966 (20.7%) were in the transcatheter percutaneous closure group, and 3,702 (79.3%) patients were included in the surgical group. All-cause mortality (OR 0.28; 95% confidence interval 0.18–0.423; p < 0.00001; I2 = 0%) and haemodynamic instability (OR 0.10; 95% confidence interval 0.05–0.21; p < 0.001; I2 = 14%) were significantly lower in the transcatheter percutaneous closure group. There was no significant difference between transcatheter and surgical patent ductus arteriosus closure for the outcomes of bronchopulmonary dysplasia (0.93; 95% confidence interval 0.46–1.87; p = 0.83; I2 = 0%) and major complications (OR 0.76; 95% confidence interval 0.34–1.69; p = 0.51; I2 = 43%).

Conclusion:

These findings suggest that transcatheter patent ductus arteriosus closure in preterm infants under 2,500 g is a safe and effective alternative to surgical treatment. There was a substantial reduction in all-cause mortality and haemodynamic instability with transcatheter intervention compared to surgical closure.

Keywords

Pretermsurgical ligationtranscatheter percutaneous closurepatent ductus arteriosuslow birth weight
Type
Review
Information
Cardiology in the Young , Volume 34 , Issue 4 , April 2024 , pp. 705 - 712
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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