Patent ductus arteriosus (PDA) is common in preterm infants and contributes to morbi-mortality. Several studies have shown the feasibility and safety of percutaneous PDA closure. Minimally invasive surgical ligation by anterior thoracotomy is an alternative, bedside technique for PDA closure in extremely low birth weight (ELBW) preterm infants. Our study aimed to compare short-term morbi-mortality between anterior mini-thoracotomy and transcatheter PDA closure.

From 2010 to 2020, 92 infants<1.6kgs underwent PDA closure in 2 centres: 44 surgical anterior mini-thoracotomies (centre 1) and 48 transcatheter closures (centre 2). Using a 1:1 propensity score match analysis, 22 patients in each group were included. The primary outcome was the time to extubation.

Preoperative characteristics were similar in both groups after propensity matching (mean weight at procedure, 1171±183gr; P=0.8). PDA closure was successful in all except 1 in the transcatheter group. Mean time to extubation was similar: 10±15 days in the surgical group versus 9±13 days in the transcatheter group (P=0.9). Mean age at hospital discharge was 114±29 days vs. 105±19 days (P=0.2). Two deaths occurred in the surgical group and one in the transcatheter group (logRank=0.61). Five complications (pneumothorax n=2, chylothorax n=2, phrenic nerve injury n=1) occurred in 3 patients after surgery. Three complications (chylothorax n=1, endocarditis n=1, renal vein thrombosis n=1) occurred in 2 patients after percutaneous closure (P=0.63).

Equivalent efficiency and safety of surgical mini-invasive vs. transcatheter PDA closure in EBLW pre-term infants are in favour of applying these alternative techniques according to centres’ facilities and competences.