# Complications of Interventional Versus Surgical Closure of Patent Ductus Arteriosus in Very Preterm Infants—A Retrospective Analysis

## TL;DR

This study compares surgical and catheter-based closure of heart defects in preterm infants, finding differences in success rates and complications.

## Contribution

The study provides a detailed comparison of complications between surgical and interventional closure of PDA in very preterm infants.

## Key findings

- Surgical ligation was associated with longer mechanical ventilation and higher bronchopulmonary dysplasia rates.
- Transcatheter closure had fewer respiratory complications but higher risk of device-related issues.
- NEC-like disease occurred in TCC patients, possibly linked to contrast agents.

## Abstract

Introduction. Patent ductus arteriosus (PDA) is the most common cardiac anomaly in preterm newborns and may aggravate respiratory disease. Invasive closure options after failure of medical treatment include surgical ligation (SL) and transcatheter closure (TCC). Reports on side effects of intravenous contrast media are scarce. Methods. In this retrospective single-center study, we compared 35 preterm infants below 1500 g birth weight undergoing SL with 35 matched infants undergoing TCC. Outcomes were procedural success, complications and postprocedural ventilation. Results. Closure success was high in both groups (97% SL vs. 86% TCC, p = 0.106). One SL patient underwent re-operation after accidental clipping of the left pulmonary artery, and eight patients (24%) had endoscopy-diagnosed vocal cord palsy after SL. Six TCC patients had complications that required further action, including device embolization, device failure and one case of late device migration that resulted in aortic arch obstruction requiring intervention, and 4 TCC patients developed necrotizing enterocolitis (NEC)-like disease within 24 h, requiring surgery in one patient. SL was associated with longer duration of mechanical ventilation (24 h vs. 144 h, p < 0.001), as opposed to TCC, and higher rates of bronchopulmonary dysplasia (86% vs. 53%, p = 0.004). Discussion. Both techniques achieve high success but differ in complication profiles. TCC may reduce respiratory morbidity. NEC-like disease (probably linked to intravenous administration of contrast agents) warrants further investigation.