Transcatheter and surgical PDA yield comparable respiratory results in very preterm infants | Image Credit: © iushakovsky - © iushakovsky - stock.adobe.com.

In closing of patent ductus arteriosus (PDA) among extremely preterm infants, similar respiratory outcomes were observed for those who underwent transcatheter closure compared to surgical ligation, according to research published in JAMA Network Open.¹

Increase in transcatheter closure for PDA

According to the study authors, transcatheter (percutaneous) closure of the PDA has increased across centers with advances in technology and optimized venous retrograde approaches. In 2019, the FDA approved a percutaneous device for use in premature infants weighing more than 700 g as early as postnatal day 3.^1,2

The authors noted that comparisons between PDA management strategies is crucial for informing optimal approaches to the PDA.¹

"The present study explored the Generic Database of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network to test the hypothesis that preterm infants undergoing transcatheter PDA closure would have fewer total ventilator days and improved secondary outcomes, including reduction in days of positive pressure ventilation, shorter length of stay, and less need for home oxygen, compared with preterm infants with PDA treated using surgical ligation," wrote the investigators.

The primary objective of the study was to characterize respiratory outcomes among infants, assessed by total days of mechanical ventilation, the primary outcome measure of the study.

The retrospective study assessed data of infants born at less than 29 weeks' gestation or who had a birth weight less than 1000 g who underwent definitive PDA closure in neonatal intensive care units between January 1, 2016 and December 31, 2020 (measured by Neonatal Research Network’s Generic Database participation). Study individuals were included if they had a PDA diagnosis and were treated with either transcatheter closure or surgical ligation during their initial hospital admission after birth.

A PDA diagnosis was defined as "clinical evidence of left-to-right PDA shunt documented by any of the following: continuous murmur, hyperdynamic precordium, bounding pulses, wide pulse pressure, congestive heart failure, increased pulmonary vasculature or cardiomegaly observed by chest radiography, increased oxygen requirement, or echocardiography evidence of PDA with left-to-right ductal shunting," according to the authors.

Transcatheter vs surgical ligation on respiratory outcomes

In all, there were 3806 included infants with a PDA diagnosis. Of these, 202 underwent transcatheter PDA closure, with a median gestational age of 25.4 weeks (24.1-27.1), of whom 56% were female. There were 359 infants who underwent surgical ligation (52% female), with a median gestational age of 24.9 weeks.

Infant age at transcatheter closure was older than at surgical ligation, with a mean age of 58.7 [28.4] vs 33.6 [16.7] days (P < .001). Following analysis adjustment for center, birth year, gestational age, age at PDA intervention, and prior pharmacologic treatment, comparable respiratory outcomes were observed across interventions. The adjusted mean difference of total days of mechanical ventilation was −2.65 (95% CI, −8.36 to 3.07 [P = .36]). Median total days of mechanical ventilation for surgical ligation vs transcatheter were not altered (46 [30-68] days vs 46 [21-73] days).

The investigators noted that infants who underwent PDA catheter closure were older than those who underwent surgical ligation, which could create the possibility of burden imbalance related to PDA exposure.

Conclusion

The authors concluded similar respiratory outcomes could be anticipated after transcatheter PDA closure vs surgical ligation, though future research to evaluate outcomes will require timing optimization of definitive PDA intervention.

References:

1. Chock VY, Bhombal S, Davis AS, et al. Respiratory Outcomes After Transcatheter vs Surgical Patent Ductus Arteriosus Closure in Preterm Infants. JAMA Netw Open. 2025;8(6):e2513366. doi:10.1001/jamanetworkopen.2025.13366

2. Sathanandam SK, Gutfinger D, O’Brien L, et al. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv. 2020;96(6):1266-1276. doi:10.1002/ccd.28973