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Treatment Options for Pediatric Patent Ductus Arteriosus: Systematic Review and Meta-analysis
Jennifer Y Lam1, Steven R Lopushinsky2, Irene W Y Ma3
1Department of Surgery, Calgary, AB, Canada.
Insights
Surgical ligation and catheter occlusion for patent ductus arteriosus (PDA) show comparable outcomes. While catheter treatment has higher reintervention rates, surgical ligation may lead to longer hospital stays. Further research is needed for optimal strategy.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Pediatric Surgery
Background:
- Patent ductus arteriosus (PDA) in nonpremature pediatric patients is typically managed with surgical ligation or catheter occlusion.
- Current evidence does not clearly favor one treatment over the other.
- This meta-analysis aims to compare clinical outcomes of surgical ligation versus catheter occlusion for PDA.
Purpose of the Study:
- To compare the clinical outcomes of surgical ligation and catheter occlusion for treating patent ductus arteriosus (PDA) in pediatric patients.
- To evaluate reintervention rates, overall complications, length of hospital stay, and cost associated with each treatment modality.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, Embase, PubMed, Cochrane) for studies published between 1950 and February 2014.
- Included studies directly compared surgical and catheter-based PDA treatments in nonpremature pediatric patients.
- Eight studies (one RCT, seven observational) involving 1,107 patients met the inclusion criteria.
Main Results:
- Pooled observational studies indicated significantly lower odds of reintervention with surgical ligation (OR, 0.12; 95% CI, 0.03-0.42).
- Overall complication rates were insignificantly higher in the surgical group (OR, 2.01; 95% CI, 0.68-5.91).
- The single RCT reported no complications but showed decreased reintervention and longer hospital stay with surgical ligation.
Conclusions:
- Both surgical ligation and catheter occlusion demonstrate comparable outcomes for PDA treatment in pediatric patients.
- Catheter-based treatment is associated with higher reintervention rates, while surgical ligation may result in a longer hospital stay.
- The study highlights potential publication and comparability biases and emphasizes the need for large, prospective randomized trials to establish optimal treatment strategies.
Background:
Patent ductus arteriosus (PDA) in the nonpremature pediatric patient is currently treated by surgical ligation or catheter occlusion. There is no clear superiority of one technique over the other. This meta-analysis compares the clinical outcomes of the two treatment options for PDA.
Methods:
We performed a literature search of MEDLINE, Embase, PubMed, and the Cochrane database of randomized controlled trials (RCTs) that took place between 1950 and February 2014 and hand-searched references from included studies. We excluded studies of adult or premature patients and those without a direct comparison between surgical and catheter-based treatments of PDAs. Outcomes of interest were reintervention, total complications, length of stay, and cost.
Results:
One thousand three hundred thirty-three manuscripts were screened. Eight studies fulfilled the inclusion criteria (one RCT and seven observational studies [N = 1,107]). In pooled observational studies, there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for reintervention in the surgical ligation group but insignificantly higher odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were no complications reported in the RCT, but surgical ligation was associated with decreased odds for reintervention and a longer length of stay. Funnel plots revealed a possible publication bias and a quality review identified comparability bias.
Conclusions:
Both therapies have comparable outcomes. Reintervention is more common with catheter-based treatment, but overall complication rates are not higher and hospital stay is shorter. Our data span > 2 decades and may not reflect current surgical and catheterization outcomes. Large, randomized, prospective studies may help determine the optimal treatment strategy.
