223 - Transcatheter Closure Versus Surgical Ligation of the Patent Ductus Arteriosus: Outcomes in Very Low Birth Weight Infants

Poster Number: 223
Publication Number: 224.33

Rhucha Joshi, University of California, Irvine, School of Medicine, Orange, CA, United States; Amir H. Ashrafi, CHOC Children's Hospital, Newport Coast, CA, United States; Sanjay Sinha, CHOC/UCI/ CS Cardiology Children's Hospital of Orange County, Redondo Beach, CA, United States; Irfan Ahmad, CHOC Children's Hospital of Orange County, Orange, CA, United States

Background: Transcatheter closure of the patent ductus arteriosus (PDA) is a safe alternative to surgical ligation in very low birth weight (VLBW) infants. As the use of transcatheter closure in PDA management increases, careful consideration must be given to its effects on neonatal morbidities and long-term outcomes.

Objective: To assess how transcatheter PDA closure compares with surgical PDA ligation in decreasing neonatal morbidities and improving outcomes in VLBW infants

Design/Methods: A retrospective review was conducted on infants admitted to CHOC Children’s Neonatal Intensive Care Unit from January 1, 2014 to June 30, 2022 who received invasive intervention for PDA. Inclusion criteria were birth weight below 1500 grams, gestational age below 32 weeks, and invasive PDA closure within the first 8 weeks of life. Infants with transcatheter closure of the PDA were matched 1:1 to infants with surgical ligation. Primary outcome was chronic lung disease, defined as oxygen requirement at 36 weeks postmenstrual age. Secondary outcomes were oxygen need at discharge, severe retinopathy of prematurity, necrotizing enterocolitis, length of stay, and survival. Data was analyzed by Mann-Whitney U test for numerical variables and Fisher exact test for categorical variables.

Results: 32 infants treated with transcatheter closure were matched with 32 infants who underwent surgical ligation. Average age at intervention was 35 days for the transcatheter closure group and 30 days for the surgical ligation group. There was no significant difference between the groups in chronic lung disease or other neonatal morbidities. Infants treated with transcatheter closure had a shorter time interval to reach full feeds but also had a higher incidence of post-operative hypothermia.

Conclusion(s): There was no difference in outcomes at discharge between transcatheter PDA closure and surgical PDA ligation. Despite being a less invasive approach, transcatheter closure was not associated with a reduction in neonatal morbidities. Earlier timing of intervention may lead to improved outcomes and should be considered in the design of prospective studies. Further research, especially in neurodevelopmental outcomes, is necessary to determine whether transcatheter closure is superior to surgical PDA ligation in the management of very low birth weight infants.