Outcomes of CDH patients receiving PDA ligation: a propensity score matched analysis.

PURPOSE: Neonates with congenital diaphragmatic hernia (CDH) have varying severity of pulmonary hypertension (PH) caused by developmental and structural abnormalities of the pulmonary vasculature and exacerbated by hypoxia induced vasoconstriction. Failure of the ductus arteriosus to close postnatally can intermittently shunt blood either to or away from the lungs. We hypothesize patent ductus arteriosus (PDA) ligation can be performed.

METHODS

We queried the Congenital Diaphragmatic Hernia Study Group registry to identify patients from 2007 to 2020 who underwent PDA ligation. We excluded patients with missing prenatal data, postnatal diagnosis > 28 days, CDH never repaired, death < 30 days, and PDA ligated on day of or before CDH repair. Patients were matched 4:1 on propensity scores for PDA ligation. The primary outcome was mortality. The secondary outcome was any use of extracorporeal life support (ECLS).

RESULTS

3953 cases were identified for analysis (3899 in no PDA ligation (-PDAL) group, 54 in PDA ligation (+ PDAL) group). After 4:1 matching, there were 196 in the -PDAL group and 49 in the + PDAL group. There was no significant difference in mortality (OR 1.1, (0.5-2.4), p = 0.811) or in use of ECLS (OR 1.5 (0.8-2.8), p = 0.218) between the two groups.

CONCLUSIONS

PDA ligation can be considered as a therapeutic option for CDH patients with persistent ductus arteriosus. It may have a role in highly selected cases that have exhausted other therapeutic options.

LEVEL OF EVIDENCE: Level III evidence.