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Surgical Ligation Versus Catheter-Based Device Closure Of Patent Ductus Arteriosus In Premature Babies
Sophie M. Voss, B.S.1, Ronald K. Woods, MD, PhD
2.
1Medical College of Wisconsin, Milwaukee, WI, USA,
2Children's Wisconsin, Milwaukee, WI, USA.
Objectives: Nationally, there has been a significant trend toward catheter-based device (CD) closure of PDAs rather than surgical ligation (SL). We sought to evaluate our institution’s outcomes with these two approaches.
Methods: This was a retrospective chart review spanning the intervals of 2019-2023 for CD and 2012-2023 for SL. Inclusion criteria were patient weight < 3 kg and prematurity (<37 weeks). We excluded the first five CD per physician to minimize learning curve bias. Univariable statistical analysis was done using R v4.3.1.
Results: The cohort included 59 CD and 111 SL patients. Table 1 provides data for each group. For the CD group, anesthesia time was longer (median 2.70 hours vs 1.45 hours for SL, p-value <0.001), and procedural time was longer (median 0.78 hours vs 0.48 hours for SL, p-value <0.001). Six CD patients (10% for CD vs 0.9% for SL, p-value=0.030) required surgical intervention—all for device migration or embolization. One died secondary to intestinal ischemia. One SL patient required surgical intervention to close a residual shunt. Three SL patients required vocal fold injection.
Conclusions: At our institution, compared to SL, CD, while being free of recurrent nerve issues, was associated with longer anesthetic and procedural times and a much higher percentage of patients requiring surgical intervention—resulting in death in one patient.
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