Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for early surgery?
Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for early surgery?

Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for early surgery?

Eur J Cardiothorac Surg. 2024 May 9:ezae175. doi: 10.1093/ejcts/ezae175. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate neonatal outcomes based on treatment strategies and time points for haemodynamically significant patent ductus arteriosus (hsPDA) in very-low-birth-weight (VLBW) preterm infants, with a particular focus on surgical closure.

METHODS: This retrospective study included VLBW infants born between 2014 and 2021, received active treatment for hsPDA. Neonatal outcomes were compared between: (1) primary surgical closure vs primary ibuprofen, (2) early (<14th post-natal day) vs late primary surgical closure (≥14th post-natal day), and (3) primary vs secondary surgical closure after ibuprofen failure. Further analysis using 1:1 propensity score matching was performed. Logistic regression was conducted to analyze the risk factors for post-ligation cardiac syndrome (PLCS) and/or acute kidney injury (AKI).

RESULTS: A total of 145 hsPDA infants underwent active treatment for closure. In-hospital death rate and severe bronchopulmonary dysplasia (BPD) were similar between the primary surgical closure group and primary ibuprofen group in 1:1 matched analysis. Severe BPD was significantly higher in late surgical closure group than in early primary surgical closure group with 1:1 propensity score matching (72.7% vs 40.9%, p=0.033). The secondary surgical closure group showed the mildest clinical condition, however, the probability of PLCS/AKI was highest (38.6%), compared to early (15.2%) or late primary surgical group (28.1%, p<0.001) especially in extremely premature infants (gestational age <28weeks).

CONCLUSIONS: Surgical PDA closure is not inferior to pharmacological treatment. Timely decision and efforts should be made considering the harmful effect of prolonged PDA shunt exposure to minimize the risk of severe BPD and PLCS/AKI after surgical closure.

PMID:38724226 | DOI:10.1093/ejcts/ezae175