Keywords
Catheter; Surgical; PDA; Children
Abstract
Objective: Patent Ductus Arteriosus (PDA) is a common Congenital Heart Disease (CHD) usually treated with catheter closure or surgical ligation. Yet, there is no superiority of one procedure over the other. No prospective randomized trials have been done comparing device closure of PDA versus surgical closure of PDA. We performed this meta-analysis to compare the outcome of both treatment options to determine which option is superior to the other.
Methods: We performed a literature search of MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, Cochrane library and literature references for articles published in the last 20 years between January 1997 and January 2017. We excluded studies of adult or premature patients, patients with other CHD, patients with metabolic or systemic disease and those without a direct comparison between surgical and catheter closure of PDAs. Outcomes of interest were success rate, residual shunt with reintervention, need for blood transfusion, complications and length of stay.
Results: Seven thousand five hundred seventy-eight articles were identified. Six studies fulfilled the inclusion criteria. Regarding success rate, no significant difference was found between surgical and catheter closure (RR: 1.01; 95% CI: 0.99- 1.03, P=0.35). Residual shunt was significantly lower in catheter closure than surgical closure (RR: 0.45, 95% CI: 0.21-0.94, P=0.03). Complications and need for blood transfusion were significantly lower in catheter closure (RR: 0.19, 95% CI: 0.11-0.32, P<0.00001) and (RR: 0.12, 95% CI: 0.05-0.32, P<0.0001) respectively. Length of hospital stay was significantly shorter after catheter closure (CI: -3.5- -3.1, P<0.0001).
Conclusion: Catheter closure was superior to surgical closure with lower residual shunt, complications, need for blood transfusion and shorter hospital stay but overall success rate was not higher than surgical closure.
Citation
Nady ME, Amrousy DE, Salah N and Zoair A. Transcatheter Versus Surgical Closure of Patent Ductus Arteriosus in Pediatric Patients: A Systematic Review With Meta-Analysis. SM J Pediatr Surg. 2017; 3(4): 1054.