Anterior mini-thoracotomy versus transcatheter closure of the patent ductus arteriosus in the extremely low birth weight preterm infant: A comparative bi-centric study

Abstract

Patent ductus arteriosus (PDA) is common in preterm infants and contributes to prolonged mechanical ventilation, renal failure, necrotizing enterocolitis and periventricular leukomalacia. Several studies have shown the feasibility and safety of percutaneous PDA closure. Minimally invasive surgical ligation by anterior thoracotomy is an alternative, bedside technique for PDA closure in extremely low birth weight preterm infants. Our study aimed to compare short-term morbi-mortality between surgical PDA ligation by anterior mini-thoracotomy and transcatheter PDA closure. From 2010 to 2020, 92 preterm babies weighing < 1.6 kgs underwent PDA closure in 2 centres: 44 surgical anterior mini-thoracotomies (group 1, centre 1) and 48 transcatheter closures (group 2, centre 2). Using a 1:1 propensity score match analysis, 44 patients were included ( n = 22 in each group). The primary outcome was the time to extubation. Preoperative characteristics were similar between the 2 groups after propensity matching (mean weight at procedure, 1171 ± 183 gr; P = 0.8). PDA closure was successful in all cases, except 1 in the transcatheter group. Mean time to extubation was similar: 10 ± 15 days in group 1 versus 9 ± 13 d. in group 2 ( P = 0.9). Mean non-invasive ventilation duration was similar ( P = 0.96). Mean age at hospital discharge was 114 ± 29 days in group 1 versus 105 ± 19 d. in group 2 ( P = 0.2). 2 deaths occurred in group 1 (9%) and 1 in group 2 (4.5%) (logRank = 0.61). 5 complications (pneumothorax n = 2, chylothorax n = 2, phrenic nerve injury n = 1) occurred in 3 patients in group 1 (13%). 3 complications (chylothorax n = 1, endocarditis n = 1, renal vein thrombosis n = 1) occurred in 2 patients of group 2 (9%) ( P = 0.63). Equivalent efficiency and safety of surgical mini-invasive versus transcatheter PDA closure in extremely low birth weight preterm infants are in favour of applying these alternative techniques according to center's facilities and competences.