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Catheterization therapy vs surgical closure in pediatric patients with patent ductus arteriosus: a meta-analysis
Kai Wang1, Xuanren Pan, Qiaoyun Tang
1Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
Insights
Catheterization for pediatric patent ductus arteriosus (PDA) shows no significant advantage in success rates or complications. However, it reduces hospital stay but increases residual shunts compared to surgery.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect in children.
- Catheterization therapy for PDA presents potential risks and complications.
- Surgical closure is a traditional treatment method for PDA.
Purpose of the Study:
- To compare the clinical effectiveness of catheterization therapy versus surgical closure for pediatric PDA.
- To conduct a meta-analysis evaluating outcomes of catheterization in pediatric PDA patients.
Main Methods:
- Systematic literature search across major biomedical databases (PubMed, Embase, etc.).
- Inclusion of controlled trials comparing catheterization therapy and surgical closure in pediatric PDA.
- Statistical analysis using relative risks (RRs) and 95% confidence intervals (CIs), assessing heterogeneity.
Main Results:
- Seven studies involving 810 pediatric PDA patients were analyzed.
- Catheterization did not significantly improve primary success rates or reduce complications and blood transfusions.
- Catheterization was linked to increased residual shunts but a shorter hospital stay.
Conclusions:
- Catheterization therapy for pediatric PDA offers no significant benefit in success rates, complications, or transfusion needs.
- Catheterization is associated with a higher incidence of residual shunts.
- Catheterization therapy leads to a reduced length of hospital stay for pediatric PDA patients.
Background:
Patent ductus arteriosus (PDA) remains a common congenital heart disease in pediatric patients, and the new trend of catheterization therapy is still associated with some potential risks and complications.
Hypothesis:
Compared with surgical closure, the clinical effect of catheterization therapy in pediatric PDA patients requires meta-analysis.
Methods:
A systematic literature search of PubMed, Cochrane Library, Embase, Science Citation Index, Web of Science, and the Chinese Biomedicine literature database was conducted. Eligible studies included controlled trials of pediatric PDA patients receiving catheterization therapy vs surgical closure. Relative risks (RRs), standard mean differences, and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I(2) test.
Results:
Seven studies with a total of 810 patients met the inclusion criteria. Catheterization therapy neither significantly increased the primary success rate (RR: 0.92, 95% CI: 0.82-1.03, P = 0.16) nor reduced the total postprocedure complications (RR: 0.74, 95% CI: 0.44-1.25, P = 0.26) and blood transfusion (RR: 1.10, 95% CI: 0.16-7.67, P = 0.93). Catheterization was associated with a statistically significant increase in residual shunts (RR: 5.19, 95% CI: 1.41-19.20, P = 0.01) and reduction in length of hospital stay (standard mean difference: -1.66, 95% CI: -2.65 to -0.67, P = 0.001).
Conclusions:
Catheterization therapy in pediatric PDA patients did not show a significant advantage in primary success rate, total complications, or blood transfusion, but it was associated with increase in residual shunts and reduction in length of hospital stay.
