Improved ventilation and hospital stay in premature babies after transcatheter closure of patent ductus arteriosus as compared to surgical ligation: A multi-center comparative study

Patent ductus arteriosus (PDA) is very common in extremely low birth weight babies and may contribute to prolonged mechanical ventilation, bronchopulmonary dysplasia, renal failure, periventricular leukomalacia and necrotizing enterocolitis. When PDA closure is indicated with failure of medical therapy (cyclooxygenase inhibitors or paracetamol), surgical ligation is usually performed with excellent results. Transcatheter closure has been recently developed with promising results but comparative studies with surgical ligation are lacking. To compare results and outcomes after transcatheter closure using the Amplatzer Piccolo device versus surgical closure in 2 matched groups of pre-term infants weighing ≤ 3000 g. One hundred and forty seven babies (3 tertiary centres) were retrospectively analysed. Sixty-four patients who underwent transcatheter closure were compared with 83 matched surgical patients, using Wilcoxon signed-rank tests. PDA closure was successful in all surgical and transcatheter cases. During NICU course, mortality was 6.3% (n = 4) after transcatheter closure and 12% (n = 10) after surgery (P = 0.24). Median duration of mechanical ventilation was shorter after transcatheter closure than after surgical ligation (3 vs. 5 days, P = 0.035). In babies undergoing duct closure before 4 weeks of age the difference between transcatheter and surgical closure for mechanical ventilation during the NICU course was even more pronounced (3 vs. 9 days, P = 0.022). When transcatheter closure was performed before 4 weeks, babies were discharged home earlier as compared to those who underwent closure later in life (39 + 1 vs. 41 + 5 weeks, P = 0.021). Such difference was not found in the surgical group. Transcatheter PDA closure in low birth weight babies is safe, effective and associated with improved mechanical ventilation as compared to surgery. It may offer shorter hospital stay when performed earlier in life.