203 - Transcatheter Closure versus Surgical Ligation of Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-analysis

Publication Number: 203.6789

Dwayne Mascarenhas, The Hospital for Sick Children, Toronto, ON, Canada; Dany E. Weisz, University of Toronto, Toronto, ON, Canada; Amish Jain, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Bonny Jasani, The Hospital for Sick Children, Toronto, ON, Canada

Background: Though transcatheter patent ductus arteriosus (PDA) closure (TCPC) is the procedure of choice for older children and adults, there exists a knowledge gap on the safety and short-term outcomes of TCPC compared to surgical ligation of PDA (SLP) in preterm infants.

Objective: To systematically review and compare the adverse events, success rate, and short-term outcomes of TCPC versus SLP for PDA closure in preterm infants.

Design/Methods: PubMed, Embase, Cochrane CENTRAL, and CINAHL were searched from inception until October 15, 2024. Studies comparing outcomes of TCPC versus SLP in preterm infants were included. Data were extracted independently by two authors. The primary outcome was major adverse events. Secondary outcomes included technical success, procedure-related mortality, adverse events, time to return to baseline respiratory severity score (RSS), time to extubation, need for inotropes, post-ligation cardiac syndrome (PLCS), bronchopulmonary dysplasia, and need for red-blood cell transfusion. Data was meta-analyzed using random-effects model and certainty of evidence assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results: Thirteen studies evaluating 1133 preterm infants were included, of which 5 studies had low risk of bias, while 8 had moderate risk of bias. There was no difference between the two groups in major adverse events [11 studies; N=895; OR 0.58; 95% CI 0.28, 1.20]. Compared to SLP group, the TCPC group had significantly lower need for inotrope use [7 studies; N=505; OR 0.27; 95% CI 0.11, 0.67], reduced incidence of PLCS [2 studies; N=198; OR 0.08; 95% CI 0.01, 0.68], shorter time to return to baseline RSS [2 studies; N=136; MD -18.7; 95% CI -23.2, -14.2], and shorter time to extubation [8 studies; N=640; MD -4.86; 95% CI -8.85, -0.87]. There were no significant differences between the two groups with regards to other pre-specified outcomes.

Conclusion(s): In comparison to SLP, TCPC appears to be safe and is associated with better post-procedure cardiorespiratory stability in preterm infants. With the increased use of TCPC as main modality for ductal closure in smaller infants, larger observational studies are needed to confirm these findings and explore further potential benefits of less invasive approaches.

Figure 1
TCPC vs SLP for PDA closure in preterm infants - Major adverse events

Figure 2
Figure 2: TCPC vs SLP for PDA closure in preterm infants – Need for inotropes

Table 1
Table 1: Summary of findings for TCPC versus SLP for PDA closure in preterm infants