Transcatheter Closure vs. Surgical Ligation in Preterm Infants with Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis

Abstract

Background: Persistent patent ductus arteriosus (pPDA) is a common condition in preterm infants. This metaanalysis aimed to assess the safety and efficacy of transcatheter closure (TC) when compared to surgical ligation (SL) in preterm infants with pPDA. Methods: A literature search of Ovid Cochrane Library, Medline, Embase, Epub, Scopus, PMC Preprints, and ClinicalTrials.Gov was conducted from inception to May 06, 2022. Eligible studies reported infants diagnosed with pPDA born at ≤2000 g birth weight or at ≤37 weeks’ who underwent TC or SL as treatment. This review was registered in PROSPERO (CRD42022325944). Results: From 97 studies screened, 8 studies met the eligibility criteria, with a total of 756 preterm infants undergoing either TC (n = 366) or SL (n = 390). Compared to TC, SL had higher mortality rates (OR = 0.32, 95% CI: 0.16, 0.66, I2 = 0%). No difference was seen in post-procedural complication rate (OR = 0.90, 95% CI: 0.18, 4.44, I2 = 79%), mean duration of post-procedural mechanical ventilation (MD = −2.21 days, 95% CI: −4.88, 0.47, I2 = 60%), hospital stay length (MD = −8.30 days, 95% CI: −17.03, 0.44, I2 = 0%) or neonatal intensive care unit stay length (MD = −3.50 days, 95% CI: −10.27, 3.27, I2 = 0%). Conclusion: Our meta-analysis demonstrated TC as a viable alternative option in managing preterm infants with pPDA in the context of SL. Despite the promising trends demonstrated in this meta-analysis, further studies with larger sample size and controlled baseline characteristics are needed to evaluate the safety and efficacy of TC and SL for preterm infants with pPDA.