Reviews Catheterization Therapy vs Surgical Closure in Pediatric Patients With Patent Ductus Arteriosus: A Meta-Analysis

Address for correspondence: Yusheng Pang Department of Pediatrics The First Affiliated Hospital of Guangxi Medical University 22 Shuangyong Road Nanning 530021, Guangxi Autonomous Region, China. [email protected]

Kai Wang, MD; Xuanren Pan, MD; Qiaoyun Tang, MD; Yusheng Pang, MD, PhD Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China

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 I2 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.

Introduction Patent ductus arteriosus (PDA) is a common congenital malformation in pediatric patients, accounting for 7% to 10% of congenital heart disease.1 Before the invention of catheterization therapy, surgical closure was recommended as the main routine treatment. As minimally invasive technology has developed, using a catheter for interventional treatment has emerged as a trend. Transcatheter closure of the PDA, first described in 1967,2 has become the preferred method of treatment for children beyond the neonatal period. The evolution of devices utilized has included the Raskind PDA Occluder (C.R. Bard, Ireland),3,4 Gianturco and Flipper coils (Cook Cardiology, Inc., Bloomington, IN),4,5 Nit-Occlud coils (NOC; PFM, Cologne, Germany),6 and the Amplatzer Ductal Occluder (ADO) I, II, and IIAS (AGA Medical Corp., Plymouth, MN).7 – 9 However, as far as pediatric patients are concerned, each of these devices may be problematic because of one or more of the following complications: risk of protrusion of the device into the aorta or pulmonary artery, The authors have no conflicts of interest to disclose. Our work was supported by The National Natural Science Foundation of China (81160040).

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Clin. Cardiol. 37, 3, 188–194 (2014) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI:10.1002/clc.22238 © 2014 Wiley Periodicals, Inc.

relatively large sheath size for small vessels, hemodynamic instability, embolization, and difficult retrieval. Neither individual randomized controlled trials nor meta-analyses of those trials have been able to demonstrate benefits of these treatments, despite their efficacy in inducing ductal closure and reducing the need for surgical closure. We undertook a meta-analysis of the comparison between the catheterization and surgical closure in pediatric PDA patients.

Methods Enrollment and Exclusion Criteria The enrollment criteria included the following: (1) retrospective cohort study; (2) all cases were pediatric patients (age

Catheterization therapy vs surgical closure in pediatric patients with patent ductus arteriosus: a meta-analysis.

Patent ductus arteriosus (PDA) remains a common congenital heart disease in pediatric patients, and the new trend of catheterization therapy is still ...
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