Surgical versus percutaneous treatment of patent ductus arteriosus in pediatric patients: an updated meta-analysis and systematic review

Background Pathologic Patent Ductus Arteriosus (PDA) is a common congenital heart defect affecting 5–10% of newborns and up to 80% of preterm neonates born before 28 weeks of gestation. While surgical ligation and minimally invasive catheter-based closure are the primary treatment options, the optimal strategy remains uncertain due to conflicting evidence regarding their efficacy, safety, and long-term cardiovascular outcomes. This study systematically compares percutaneous versus surgical PDA closure in pediatric patients, focusing on effectiveness, safety, and procedural risks. Methods Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane Central databases, identifying randomized controlled trials (RCTs) and cohort studies comparing surgical ligation versus percutaneous closure for PDA in pediatric patients. We assessed the primary procedure success, peri- and post-procedural complications, and the presence of residual shunts. The risk ratio (RR) with 95% confidence intervals (CI) was used for dichotomous outcomes. Heterogeneity was assessed using the I² statistic. All statistical analyses were carried out using R software (version 4.2.2). Results Fifteen studies were included, comprising 4,619 patients, of whom 2,250 underwent percutaneous PDA closure. The surgical ligation was significantly associated with a higher primary procedure success rate compared to percutaneous intervention (RR 0.92; 95% CI 0.84–0.99; p=0.036). In addition, the incidence of residual shunt was significantly lower in the surgical group (RR 5.01; 95% CI 1.32–19.02; p=0.018). However, the percutaneous strategy was significantly associated with a lower occurrence of procedure complications (RR 0.74; 95% CI 0.62–0.89; p < 0.01). Conclusion Surgical intervention for PDA closure in pediatric patients demonstrated superior effectiveness in achieving complete ductal closure, with higher procedural success and lower residual shunt rates than percutaneous approaches. However, its higher complication rates highlight the importance of individualized treatment selection, considering patient-specific risks and clinical context. These findings underscore the importance of refining patient selection criteria to optimize outcomes in pediatric PDA management.