Meta-Analysis of Surgery vs. Percutaneous Treatment for Pediatric Patent Ductus Arteriosus | Journal Scan

Study Questions:

What is the optimal approach for closure of patent ductus arteriosus (PDA) in pediatric patients?

Methods:

A systematic review and meta-analysis was performed. Studies involving adults or premature infants were excluded. Outcomes of interest included the need for re-intervention, complications, length of stay, and cost.

Results:

A total of 1,333 manuscripts were screened, of which eight fulfilled the inclusion criteria (one randomized controlled trial and seven observational studies totaling 1,107 patients). In pooled observational studies, there was a significantly decreased need for re-intervention in the surgical ligation group (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.42). There was an insignificantly higher odds of overall complications with surgical ligation (OR, 2.01; 95% CI, 0.68-5.91). There were no complications reported in the randomized controlled trial, in which surgical ligation was associated with decreased odds for re-intervention and a longer length of stay. Additional analysis suggested possible publication bias and comparability bias in the studies used for the meta-analysis.

Conclusions:

Surgical and transcatheter therapies have comparable outcomes, with somewhat higher need for re-intervention after a transcatheter approach. The authors concluded that large, randomized studies may help determine the optimal treatment strategy.

Perspective:

In adults, transcatheter closure of patent ductus is generally preferred because of calcification of the ductus. In children, both transcatheter closure and surgical ligation are performed. The mode of closure may be dependent on center preference/capabilities as well as by size of the patient and anatomy of the ductus. This meta-analysis is limited by issues with the studies used, as well as by heterogeneity of patient ductus arteriosus anatomy and potential interventions. Surgery can be performed either via thoracotomy or with video-assisted thoracoscopy, while transcatheter closure can be performed with coils, or a variety of closure devices. Although further randomized trials may be helpful, they will be faced with similar challenges seen in existing studies, related to heterogeneous ductus anatomy and differing therapeutic approaches.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Interventions, Interventions and Structural Heart Disease

Keywords: Calcification, Physiologic, Cardiac Surgical Procedures, Child, Ductus Arteriosus, Ductus Arteriosus, Patent, Heart Defects, Congenital, Length of Stay, Ligation, Pediatrics, Publication Bias, Specialties, Surgical, Thoracoscopy, Thoracotomy


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