title: Treatment Options for Pediatric Patent Ductus Arteriosus: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Patent ductus arteriosus (PDA) in the nonpremature pediatric patient is currently treated by surgical ligation or catheter occlusion. There is no clear superiority of one technique over the other. This meta-analysis compares the clinical outcomes of the two treatment options for PDA.
  
  
  METHODS
  We performed a literature search of MEDLINE, Embase, PubMed, and the Cochrane database of randomized controlled trials (RCTs) that took place between 1950 and February 2014 and hand-searched references from included studies. We excluded studies of adult or premature patients and those without a direct comparison between surgical and catheter-based treatments of PDAs. Outcomes of interest were reintervention, total complications, length of stay, and cost.
  
  
  RESULTS
  One thousand three hundred thirty-three manuscripts were screened. Eight studies fulfilled the inclusion criteria (one RCT and seven observational studies [N = 1,107]). In pooled observational studies, there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for reintervention in the surgical ligation group but insignificantly higher odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were no complications reported in the RCT, but surgical ligation was associated with decreased odds for reintervention and a longer length of stay. Funnel plots revealed a possible publication bias and a quality review identified comparability bias.
  
  
  CONCLUSIONS
  Both therapies have comparable outcomes. Reintervention is more common with catheter-based treatment, but overall complication rates are not higher and hospital stay is shorter. Our data span > 2 decades and may not reflect current surgical and catheterization outcomes. Large, randomized, prospective studies may help determine the optimal treatment strategy.
authors.affiliation: Department of Surgery, Calgary, AB, Canada.
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Lam
authors.affiliation: Department of Surgery, Calgary, AB, Canada; Division of Pediatric General Surgery, Calgary, AB, Canada.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lopushinsky
authors.affiliation: Division of General Internal Medicine, Calgary, AB, Canada.
authors.forename: Irene W Y
authors.initials: IWY
authors.lastname: Ma
authors.affiliation: Department of Medicine, and the Division of Cardiology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Dicke
authors.affiliation: Division of Pediatric General Surgery, Calgary, AB, Canada; Department of Surgery, Calgary, AB, Canada. Electronic address: maryebrindle@gmail.com.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brindle
mesh_terms: D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D011183:Postoperative Complications