Efficacy and safety of surgical closure of patent ductus arteriosus in preterm infants: experience from a level III NICU

Abstract

Patent ductus arteriosus (PDA) is prevalent in preterm infants. When hemodynamically significant, PDA closure is recommended, either pharmacologically or surgically. There is still no consensus for the standard PDA management strategy. We aimed to evaluate efficacy and safety of surgical ligation of hemodynamically significant PDA (hs-PDA). A retrospective study was performed of all premature neonates < 28 weeks of gestational age and/or birth weight < 1000 grams admitted to a level III Neonatal Intensive Care Unit (NICU) from January 2010 to June 2020 who were submitted to a systematic echocardiographic screening and neonates transferred for evaluation and/or treatment of PDA; patients with ductal-dependent congenital heart disease and PDA with a right-to-left (or bidirectional) shunt were excluded. A total of 131 infants were included: 93 (71%) with hs-PDA. Of the 82 infants that completed treatment, 58 (70.7%) were medically treated and 24 (29.3%) submitted to surgery; 21 (87.5%) of surgically treated patients were previously submitted to medical treatment. Infants with hs-PDA (vs. without hs-PDA) and infants with surgically treated PDA (vs. medically treated PDA) had lower gestational age, lower birth weight and higher incidence of intraventricular hemorrhage. Preoperatively, the average diameter of the PDA was 2.2 mm and the median LA/Ao ratio was 1.7. No intraoperative complications were described. After surgery, seven (29.2%) neonates developed hemodynamic instability and three (12.5%) died within the first 24 hours. We concluded that surgical ligation is an effective option to be considered when pharmacological treatment has failed or is contraindicated.