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Ann Thorac Surg 2009;87:1509-1516. doi:10.1016/j.athoracsur.2008.12.101
© 2009 The Society of Thoracic Surgeons
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Massimo A. Padalino
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Original Articles: Pediatric Cardiac

Is There an Optimal Timing for Surgical Ligation of Patent Ductus Arteriosus in Preterm Infants?

Vladimiro L. Vida, MDa,*, Paola Lago, MDb, Sabrina Salvatori, MDb, Giovanna Boccuzzo, PhDc, Massimo A. Padalino, MD, PhDa, Ornella Milanesi, MDb, Simone Speggiorin, MDa, Giovanni Stellin, MDa

a Department of Pediatric and Congenital Cardiac Surgery, University of Padua, Padua, Italy
b Department of Pediatrics, University of Padua, Padua, Italy
c Department of Statistics, University of Padua, Padua, Italy

Accepted for publication December 17, 2008.

* Address correspondence to Dr Vida, Pediatric and Congenital Cardiac Surgery Unit, Via Giustiniani 2, Padua, 35100, Italy (Email: vladimirovida{at}yahoo.it).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: We sought to define the variables associated with hospital outcome in preterm infants with patent ductus arteriosus (PDA) and identify the optimal timing for PDA closure to improve hospital outcome.

Methods: Included were 201 premature babies (≤ 32 weeks gestational age), from January 2001 to June 2007, with PDA who received primary medical treatment with ibuprofen. Number of ibuprofen cycles, gestational age, body weight, and presence of symptomatic hypotension requiring vasoactive/inotropic drugs were related to hospital outcome, including hospital mortality, presence of necrotizing enterocolitis, acute renal failure, intraventricular hemorrhage, retinopathy and bronchopulmonary dysplasia at week 36. Data were analyzed with a logistic regression model.

Results: Medical treatment was effective in 149 patients (75%), but 52 (25%) required surgical ligation after medical treatment failed. They had younger gestational age (25 weeks [IQR, 24 to 27 weeks] vs 27 weeks [IQR, 25 to 28 weeks], p < 0.0001), lower body weight at birth (730 g [IQR, 595 to 915 g] vs 840 g [IQR, 670 to 1016], p = 0.05), and a higher incidence of symptomatic hypotension (38 of 52 [73%] vs 56 of 149 [38%], p < 0.0001) than patients who responded to ibuprofen. More than two cycles of ibuprofen was significantly associated with an increased risk for bronchopulmonary dysplasia (odds ratio [OR], 2.81; p = 0.03) and acute renal failure (OR, 3.81; p = 0.09).

Conclusions: The prolonged patency of the ductus arteriosus in preterm infants is related to an increased morbidity. Surgical ligation of PDA is a safe and effective treatment and should be done soon after two complete cycles of ibuprofen, especially in selected patients, to improve clinical outcome.






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