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

Abstract

<b>Background:</b> Persistent patent ductus arteriosus (pPDA) is a common condition in preterm infants. This meta-analysis aimed to assess the safety and efficacy of transcatheter closure (TC) when compared to surgical ligation (SL) in preterm infants with pPDA. <b>Methods:</b> A literature search of Ovid Cochrane Library, Medline, Embase, Epub, Scopus, PMC Preprints, and 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). <b>Results:</b> 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%). <b>Conclusion:</b> 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.