Patent ductus arteriosus ligation in neonates: preoperative predictors of poor postoperative outcomes

Purpose: The purpose of this study was to identify preoperative predictors of adverse outcomes in infants undergoing surgical ligation of patent ductus arteriosus (PDA). Methods: Charts of all neonates who underwent PDA ligation at Texas Children's Hospital (Houston, TX) between 2001 and 2006 were retrospectively reviewed with specific attention to preoperative clinical characteristics, echocardiographic details, operative morbidity, and postoperative outcomes. Infants with other cardiac anomalies or right-to-left or bidirectional PDA shunt were excluded. Results: Eighty-two neonates were included (mean gestational age, 27 weeks; mean birth weight, 1000 g). There were no intraoperative complications. Preoperative symptoms related to respiratory insufficiency, hypotension, apnea, and pulmonary edema improved after ligation (P < .001). Birth weight, age at ligation, and indomethacin use did not correlate with postoperative outcome; however, lower gestational age, lower blood pressure, and lower shunt peak velocity predicted longer time to extubation by multiple analysis techniques (P < .0001). Linear regression (controlling for gestation, birth weight, and mean arterial pressure) showed inverse correlation between peak velocity and postoperative days on the ventilator (95% confidence interval, 47.18 to -12.25; P = .001). Conclusion: The PDA ligation can be accomplished safely; however, some neonates have prolonged recovery. Lower gestational age and low peak velocity (<2.6 m/s) at the PDA shunt correlate with lengthened ventilator requirement after surgery.