Frequency and outcomes of surgical and transcatheter closure of patent ductus arteriosus in preterm infants in Germany—a prospective nationwide hospital-based surveillance study

Abstract Treatment strategies in patent ductus arteriosus (PDA) in preterm infants (PIs) have evolved in recent years and vary substantially between centers. While recent recommendations increasingly advocate for a more conservative approach to PDA management, transcatheter PDA closure (TCPC) has simultaneously become a well-established alternative to surgical ligation—even in very small PIs—after failure of medical treatment. Particularly in light of the ongoing conflicting perspectives in the field of optimal PDA management in PIs, our objective was to compare frequency, efficiency, and complications of surgical closure versus TCPC in a real-world setting. Between 2022 and 2023, we conducted a prospective nationwide hospital-based surveillance study including preterm infants < 32 weeks gestation and < 1500 g birthweight who underwent either surgical or transcatheter PDA closure. Standardized data on PDA treatment strategies, including medical therapy and complications, were collected by the German Paediatric Surveillance Unit (GPSU) and outcomes evaluated using the Desirability of Outcome Ranking (DOOR) method. Data from 110 infants were analyzed. Ninety-three percent (102/110) received at least one kind of medical treatment before definite mechanical closure with ibuprofen most widely used followed by paracetamol. Surgical closure was performed in 70 infants and transcatheter closure in 40 infants. Infants in the surgical group were more immature at birth (24 + 3 weeks [IQR 23 + 5–25 + 3] vs. 25 + 3 weeks [IQR 24 + 3–27 + 0], p 0.001), had lower birthweight (635 g vs. 733 g, p 0.009), and had lower weight at the time of surgery compared to catheterization (915 g vs. 1200 g, p < 0.001). Complications were reported in 15% (10/68) after surgical closure and in 26% (10/39) after TCPC but did not differ in the DOOR analysis. Conclusion : In this nationwide study from Germany, transcatheter PDA closure was performed in approximately one-third of preterm infants, whereas surgical closure remained the predominant approach, particularly in smaller and more immature infants. The high incidence of adverse events following both methods—TCPC and surgical closure—warrants close ongoing surveillance. Substantial off-label use of paracetamol reflects evolving medical practice. What is Known: • PDA in PIs remains a common clinical challenge, with a wide range of treatment strategies across NICUs. • New transcatheter PDA closure (TCPC) devices have recently been approved for use in preterm infants weighing > 700 g, expanding interventional options in this vulnerable population. What is New: • Surgical PDA closure seems to be still the preferred PDA treatment option in Germany especially in more immature infants. • Overall safety demonstrated no meaningful difference between TCPC and surgical PDA closure.