https://orcid.org/0000-0002-1038-4955
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Katrien François, Prematurity and patent ductus arteriosus: a surgical clip may save the lungs!, European Journal of Cardio-Thoracic Surgery, Volume 65, Issue 6, June 2024, ezae232, https://doi.org/10.1093/ejcts/ezae232
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The optimal treatment of a haemodynamically significant patent ductus arteriosus (hsPDA) in very-low-birth-weight premature babies remains a matter of debate, and the treatment algorithms have fluctuated over the last decades. In the search for minimal invasiveness, surgical duct closure is less and less been considered. A recent randomized trial and a Cochrane review have focused on comparing expectant management with active medical ibuprofen treatment, without even considering to include a surgical treatment arm [1, 2]. In our daily practice, it has indeed become very rare to get a request from the neonatology department to close a patent duct surgically in a low-birth-weight premature baby.
This attitude towards avoiding surgery in fragile babies has clearly not been advocated in other parts of the world. In a large retrospective study from Korea, Lee et al. studied the role of surgery in 422 premature babies weighing <1500 g, treated from 2014 to 2021 [3]. From the 186 premature babies with hsPDA, 102 received primary surgical closure, 43 got primary ibuprofen and 41 received expectant treatment. The study conclusions were interesting: in a propensity-matched analysis, in-hospital death and the occurrence of severe bronchopulmonary dysplasia were similar between the primary surgical closure group and the primary ibuprofen group, and surgery did not lead to increased complication rate. When the surgery was performed early, which was defined as before 14 days of age, severe bronchopulmonary dysplasia was clearly less frequent (41% vs 73%). Furthermore, the incidence of necrotizing enterocolitis was low (7.1%), and occurred only in the late surgical closure group. Patients in whom secondary surgical closure was needed after failed medical treatment had a higher risk for post-ligation cardiac failure and acute renal injury, particularly in babies of <28 weeks gestational age.
