Preterm neonates, especially those with extremely low birth weights, frequently develop patent ductus arteriosus (PDA). Timely intervention is necessary because persistent PDA can lead to significant morbidities and increased mortality. The purpose of this meta-analysis was to evaluate the safety and effectiveness associated with transcatheter closure compared with surgical ligation for PDA in neonates. We systematically searched PubMed, Embase, and Cochrane from inception to July 2025 for studies (randomized and observational cohorts) comparing transcatheter PDA closure and surgical PDA ligation in infants with PDA. Primary outcomes were all-cause mortality, bronchopulmonary dysplasia, periventricular leukomalacia, and intraventricular hemorrhage. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed using I 2 statistics. Transcatheter closure was associated with lower hemodynamic instability (RR: 0.22; 95% CI: 0.09–0.53) and lower all-cause mortality (RR: 0.34; 95% CI: 0.23–0.49) among 5598 neonates. It was also associated with fewer cases of periventricular leukomalacia and shorter neonatal intensive care unit (NICU) stays. No significant differences were observed in total hospitalization, complications, intraventricular hemorrhage, or bronchopulmonary dysplasia. Sensitivity analyses indicated low heterogeneity and consistent findings across studies. Transcatheter PDA closure was associated with lower mortality, improved hemodynamic stability, and shorter NICU stay compared with surgical ligation, while maintaining a comparable safety profile. Because most included studies were observational, these associations should be interpreted cautiously rather than as causal effects.
Iqbal et al. (Tue,) studied this question.