Anterior mini-thoracotomy versus transcatheter closure of the patent ductus arteriosus in the extremely low birth weight preterm infant: A comparative bi-centric study

Introduction Patent ductus arteriosus (PDA) is common in preterm infants and contributes to prolonged mechanical ventilation, renal failure, necrotizing enterocolitis and periventricular leukomalacia. Several studies have shown the feasibility and safety of percutaneous PDA closure. Minimally invasive surgical ligation by anterior thoracotomy is an alternative, bedside technique for PDA closure in extremely low birth weight preterm infants. Purpose Our study aimed to compare short-term morbi-mortality between surgical PDA ligation by anterior mini-thoracotomy and transcatheter PDA closure. Methods From 2010 to 2020, 92 preterm babies weighing Results Preoperative characteristics were similar between the 2 groups after propensity matching (mean weight at procedure, 1171 ± 183 gr; P = 0.8). PDA closure was successful in all cases, except 1 in the transcatheter group. Mean time to extubation was similar: 10 ± 15 days in group 1 versus 9 ± 13 d. in group 2 (P = 0.9). Mean non-invasive ventilation duration was similar (P = 0.96). Mean age at hospital discharge was 114 ± 29 days in group 1 versus 105 ± 19 d. in group 2 (P = 0.2). 2 deaths occurred in group 1 (9%) and 1 in group 2 (4.5%) (logRank = 0.61). 5 complications (pneumothorax n = 2, chylothorax n = 2, phrenic nerve injury n = 1) occurred in 3 patients in group 1 (13%). 3 complications (chylothorax n = 1, endocarditis n = 1, renal vein thrombosis n = 1) occurred in 2 patients of group 2 (9%) (P = 0.63). Conclusion Equivalent efficiency and safety of surgical mini-invasive versus transcatheter PDA closure in extremely low birth weight preterm infants are in favour of applying these alternative techniques according to center's facilities and competences.