Percutaneous closure of very low weight preterm new-borns ductus arteriosus prevents post ligature cardiac syndrome and reduces all-cause mortality compared to surgery

Abstract

Post ligature cardiac syndrome (PLCS) is a serious complication of surgical closure of the ductus arteriosus (DA) of preterm infants. Incidence of PLCS after percutaneous closure is poorly studied. The aim of this study was to compare the incidence of PLCS between percutaneous and surgical DA closure techniques. Mortality, major and minor post-procedural complications, and risk factors for PLCS had also been explored. We conducted a retrospective study including premature infants weighing less than 2000 g who had surgical (surgical group) or percutaneous (KT group) closure of the DA at Nantes University Hospital and Tours University Hospital between 2009 and 2021. Seventy-six children were included in the KT group and 78 in the surgery group. No cases of PLCS were diagnosed in the KT group versus 10 in the surgery group (0% vs. 13%, P < 0.01). Pre-discharge mortality was lower in the KT group (3% vs. 18%, P < 0.01). The rate of major complications also tended to be lower (5% vs. 15%, P = 0.07). Surgery (100% vs. 47%, P < 0.01), lower birth term (25 ± 1 vs. 26 ± 2 weeks, P < 0.05) and need for amines before closure procedure (90% vs. 26%, P < 0.001) were significantly associated with PLCS. Finally, PLCS significantly increased pre-discharge mortality (40% vs. 8%, P < 0.01). With no cases of PLCS and a reduction in all-cause mortality before discharge, our results suggest that percutaneous closure of the DA of preterm infants would be preferred to surgical closure. This technique must still be improved and widely diffused.