Percutaneous closure of patent ductus arteriosus versus surgical treatment in low-birth-weight preterms: a systematic review and meta-analysis.

Autor:	Melchior CDS; Universidade Iguaçu, Rio de Janeiro, Brazil., Neves GR; Universidade do Estado do Pará, Pará, Brazil., de Oliveira BL; Centro Universitário Católico Salesiano Auxilium Araçatuba, São Paulo, Brazil., Toguchi AC; Centro Universitário São Camilo, São Paulo, Brazil., Lopes JC; Universidade Federal do Tocantins, Tocantins, Brazil., Pavione MA; Universidade Tiradentes, Sergipe, Brazil., Enríquez SKT; Hospital de Especialidades Santa Margarita, Portoviejo, Ecuador.
Jazyk:	angličtina
Zdroj:	Cardiology in the young [Cardiol Young] 2024 Apr; Vol. 34 (4), pp. 705-712. Date of Electronic Publication: 2024 Feb 08.
DOI:	10.1017/S1047951123004353
Abstrakt:	Introduction: The optimal management of a patent ductus arteriosus in a population of preterm infants is controversial. Traditionally, when the patent ductus arteriosus does not close either with conservative treatment or in response to pharmacological therapy, the only option is surgical closure. However, transcatheter occlusion might provide a therapeutic alternative. Methods: We searched PubMed, Embase, and Cochrane databases for non-randomised and randomised controlled trials that compared transcatheter percutaneous closure of patent ductus arteriosus with surgical ligation in low-birth-weight preterm infants (<2,500 g). A random-effects model was used for outcomes with high heterogeneity. Results: We included twelve studies comprising 4,668 low-birth-weight preterm infants, of whom 966 (20.7%) were in the transcatheter percutaneous closure group, and 3,702 (79.3%) patients were included in the surgical group. All-cause mortality (OR 0.28; 95% confidence interval 0.18-0.423; p < 0.00001; I 2 = 0%) and haemodynamic instability (OR 0.10; 95% confidence interval 0.05-0.21; p < 0.001; I 2 = 14%) were significantly lower in the transcatheter percutaneous closure group. There was no significant difference between transcatheter and surgical patent ductus arteriosus closure for the outcomes of bronchopulmonary dysplasia (0.93; 95% confidence interval 0.46-1.87; p = 0.83; I 2 = 0%) and major complications (OR 0.76; 95% confidence interval 0.34-1.69; p = 0.51; I 2 = 43%). Conclusion: These findings suggest that transcatheter patent ductus arteriosus closure in preterm infants under 2,500 g is a safe and effective alternative to surgical treatment. There was a substantial reduction in all-cause mortality and haemodynamic instability with transcatheter intervention compared to surgical closure.
Databáze:	MEDLINE
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