Eastern Cardiothoracic Surgical Society

Bedside Surgical Ligation of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants is Safe and Efficacious
William Lorenz, Andrew Herman, Benjamin Peeler, Thomas Maxey, Levine Children’s Hospital, Charlotte, NC

OBJECTIVE: Identifying ideal treatment for preterm infants with symptomatic patent ductus arteriosus (PDA) is challenging. The decisions involved in selection and timing of referral for surgical ligation remain controversial, particularly in extremely low birth weight infants (ELBWI). We studied the short and long term outcomes of ELBWI to evaluate the safety and efficacy of bedside surgical ligation in this specific population.

METHODS: A retrospective review of all neonates who underwent isolated surgical ligation of PDA from January 2007-March 2014. All surgeries were performed at the bedside in a single 85 bed NICU. Exclusion criteria included: significant genetic syndromes and concomitant congenital heart disease. Two groups: Group 1(infants 750 grams) vs. Group 2 (infants >750 grams) were compared for morbidity and mortality.

RESULTS: 221 infants were identified and included in analysis. Group 1 (n=100) demonstrated significantly higher incidence of preoperative hypotension (39.36% vs. 15.52%, p=0.00004) vs. Group 2 (n=121). There were no significant differences in surgical timing, preoperative workup, or intraoperative complications between groups. Gestational age was not an independent predictor of morbidity or mortality in this surgical cohort. Specifically, there were no significant differences in postoperative necrotizing enterocolitis, chronic lung disease, or vocal cord injury. Survival to discharge was not significantly different between groups (92.3% vs 94.9% p=0.44). Group 1 had significantly greater severe retinopathy of prematurity (26.67% vs. 8.4%, p=0.0004) and renal dysfunction (24.72% vs. 12.93%, p=0.02962) compared to Group 2.

CONCLUSIONS: Bedside surgical ligation of PDA in ELBW infants is safe and efficacious in this fragile patient population.