The evolution of ductus arteriosus treatment

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Patent ductus arteriosus (PDA) is a common congenital heart defect.
• Treatment strategies for PDA have evolved, moving towards less invasive options.
• Comparing surgical and transcatheter closure outcomes is crucial for clinical decision-making.

Purpose of the Study:

• To compare the outcomes of surgical closure versus transcatheter coil occlusion for patent ductus arteriosus in non-premature children.
• To evaluate complication rates, length of stay, and residual PDA rates for both treatment modalities.

Main Methods:

• Retrospective review of 231 children undergoing surgical PDA closure (1985-1997).
• Retrospective review of 30 children undergoing transcatheter coil occlusion for PDA (1995-1998).
• Analysis of intra-operative data, post-operative complications, length of stay, and echocardiographic follow-up.

Main Results:

• Surgical closure had a low mortality (0.4%) and decreased chest tube use over time. Postoperative complications included pneumothoraces and vocal cord paralysis. Median length of stay was 5 days.
• Transcatheter closure resulted in vascular complications in 13.3% and required a second intervention in some cases. Residual PDA rates were comparable between groups at follow-up.
• Surgical closure demonstrated significant improvements in intra-operative chest tube use, decreasing from 73.3% to 10% over the study period.

Conclusions:

• Both surgical and transcatheter closure are effective treatments for PDA in children.
• Surgical closure has shown improvements in technique and outcomes over time, with a low complication rate.
• Transcatheter coil occlusion is a viable alternative, though vascular complications and need for reintervention should be considered.