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Comparative Study
. 2025 Jun 2;8(6):e2513366.
doi: 10.1001/jamanetworkopen.2025.13366.

Respiratory Outcomes After Transcatheter vs Surgical Patent Ductus Arteriosus Closure in Preterm Infants

Valerie Y Chock  1 , Shazia Bhombal  2 , Alexis S Davis  1 , Meera N Sankar  1 , Barbara T Do  3 , Matthew M Laughon  4 , Krisa P Van Meurs  1 , Carl H Backes  5 , Patrick J McNamara  6 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Comparative Study

Respiratory Outcomes After Transcatheter vs Surgical Patent Ductus Arteriosus Closure in Preterm Infants

Valerie Y Chock et al. JAMA Netw Open. .

Abstract

Importance: Transcatheter closure of the patent ductus arteriosus (PDA) has increasingly been adopted in extremely preterm infants as a method to definitively close the PDA while avoiding the inherent risks of surgical ligation. Differences in respiratory outcomes after transcatheter closure compared with surgical ligation have not been substantiated, particularly in the context of timing of the intervention.

Objective: To characterize respiratory outcomes in extremely preterm infants with PDA treated with transcatheter device closure compared with surgical ligation.

Design, setting, and participants: This retrospective cohort study assessed data from preterm infants born at less than 29 weeks' gestation or with birth weight less than 1000 g who underwent definitive PDA closure in neonatal intensive care units participating in the Neonatal Research Network's Generic Database between January 1, 2016, and December 31, 2020. Data were analyzed from October 2021 to February 2024.

Exposures: PDA treatment with transcatheter device closure or with surgical ligation.

Main outcomes and measures: The primary outcome was total days of mechanical ventilation.

Results: Of 3806 included infants with a PDA diagnosis, 202 underwent transcatheter PDA closure (median [IQR] gestational age, 25.4 [24.1-27.1] weeks; 114 [56%] female) and 359 underwent surgical ligation (median [IQR] gestational age, 24.9 [24.0-25.9] weeks; 187 [52%] female). Infant age at transcatheter closure was older than at surgical ligation (mean [SD], 58.7 [28.4] vs 33.6 [16.7] days; P < .001). After adjustment of analyses for center, birth year, gestational age, age at PDA intervention, and prior pharmacologic treatment, infants with transcatheter closure compared with surgical ligation had comparable respiratory outcomes, including total days of mechanical ventilation (adjusted median difference, -2.65 [95% CI, -8.36 to 3.07] days; P = .36).

Conclusions and relevance: In this cohort study of extremely preterm infants who underwent transcatheter closure compared with surgical ligation for treatment of PDA, respiratory outcomes did not differ, although the transcatheter closure group had a longer duration of PDA exposure. Future research evaluating outcomes after transcatheter PDA closure should assess the optimal timing of definitive intervention.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chock reported receiving grants from Nationwide Children's Hospital outside the submitted work. Dr Davis reported receiving personal fees from Lansinoh outside the submitted work. Mrs Do reported receiving grants from RTI International during the conduct of the study. Dr Laughon reported receiving grants from the National Institutes of Health during the conduct of the study. Dr McNamara reported receiving personal fees from Abbott Cardiac during the conduct of the study and from Aspect Imaging outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Population Flow Diagram
PDA represents patent ductus arteriosus. aExcludes infants who were outborn or had congenital malformations or syndromes.
Figure 2.
Figure 2.. Patent Ductus Arteriosus (PDA) Treatment by Birth Year
See this image and copyright information in PMC

References

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