Transcatheter PDA closure may be superior to surgery in neonates, infants
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Compared with surgical ligation, transcatheter closure of the patent ductus arteriosus in infants and neonates was associated with reduced mortality rates and lower length of stay, researchers reported.
Michael T. Kuntz, MD, pediatric anesthesiology fellow at Boston Children’s Hospital, and colleagues retrospectively analyzed 678 patients younger than 1 year from the 2016 to 2020 Pediatric Health Information System database who underwent patent ductus arteriosus (PDA) closure via a surgical or transcatheter procedure.
Compared with the transcatheter group, the surgical group was younger (0.1 years vs. 0.53 years; P < .001) and more likely to be premature (60% vs. 20.3%; P < .001), according to the researchers.
The mortality rates were 1.7% in the surgical group and 0% in the transcatheter group (P = .02).
The mortality difference “is not entirely surprising given the higher rate of comorbid conditions in surgical patients,” Kuntz and colleagues wrote.
In multivariable-adjusted analyses, compared with the surgical group, the transcatheter group had lower odds of being admitted to the ICU (OR = 0.2; 95% CI, 0.11-0.32; P < .001) and requiring mechanical ventilation (OR = 0.3; 95% CI, 0.19-0.56; P < .001).
In addition, Kuntz and colleagues found, the transcatheter group compared with the surgery group had shorter hospital stays (adjusted coefficient, 2 days shorter; 95% CI, 1.3-2.7; P < .001) and shorter postoperative stays (adjusted coefficient, 1.2 days shorter; 95% CI, 0.1-2.3; P = .039).
There were no significant differences between the groups in overall charges and readmission rates.
For the premature infants and neonates, compared with the transcatheter group, the surgery group had longer hospital stays (adjusted difference in medians, 4 days; 95% CI, 1.7-6.3; P < .001) and longer postoperative stays (adjusted difference in medians, 3 days; 95% CI, 1.1-4.9; P = .002), according to the researchers.
The percentage of transcatheter procedures performed increased from 2016 to 2020, the researchers wrote, noting the FDA approval of a transcatheter device for infants as small as 700 g (Amplatzer Piccolo Occluder, Abbott) in January 2019 may have played a role.
“Our study confirms that transcatheter closure rates continue to increase compared with surgical ligation of PDA,” Kuntz and colleagues wrote. “Patients undergoing transcatheter closure have shorter postoperative length of stay and lower mortality. Prospective clinical trials are necessary to evaluate clinically relevant differences, such as low cardiac output syndrome following transcatheter closure vs. surgical ligation.”
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