Respiratory Outcomes After Transcatheter vs Surgical Patent Ductus Arteriosus Closure in Preterm Infants

Abstract

IMPORTANCE Transcatheter closure of the patent ductus arteriosus (PDA) has increasingly been adopted in extremely preterm infants as a method to definitively close the PDA while avoiding the inherent risks of surgical ligation. Differences in respiratory outcomes after transcatheter closure compared with surgical ligation have not been substantiated, particularly in the context of timing of the intervention. OBJECTIVE To characterize respiratory outcomes in extremely preterm infants with PDA treated with transcatheter device closure compared with surgical ligation. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed data from preterm infants born at less than 29 weeks' gestation or with birth weight less than 1000 g who underwent definitive PDA closure in neonatal intensive care units participating in the Neonatal Research Network's Generic Database between January 1, 2016, and December 31, 2020. Data were analyzed from October 2021 to February 2024. EXPOSURES PDA treatment with transcatheter device closure or with surgical ligation. MAIN OUTCOMES AND MEASURES The primary outcome was total days of mechanical ventilation. RESULTS Of 3806 included infants with a PDA diagnosis, 202 underwent transcatheter PDA closure (median [IQR] gestational age, 25.4 [24.1-27.1] weeks; 114 [56%] female) and 359 underwent surgical ligation (median [IQR] gestational age, 24.9 [24.0-25.9] weeks; 187 [52%] female). Infant age at transcatheter closure was older than at surgical ligation (mean [SD], 58.7 [28.4] vs 33.6 [16.7] days; P < .001). After adjustment of analyses for center, birth year, gestational age, age at PDA intervention, and prior pharmacologic treatment, infants with transcatheter closure compared with surgical ligation had comparable respiratory outcomes, including total days of mechanical ventilation (adjusted median difference, -2.65 [95% CI, -8.36 to 3.07] days; P = .36). CONCLUSIONS AND RELEVANCE In this cohort study of extremely preterm infants who underwent transcatheter closure compared with surgical ligation for treatment of PDA, respiratory outcomes did not differ, although the transcatheter closure group had a longer duration of PDA exposure. Future research evaluating outcomes after transcatheter PDA closure should assess the optimal timing of definitive intervention.