Comparison of early and late surgical ligation of patent ductus arteriosus in preterm infants.

The early ligation group had a significantly higher left atrial to aortic root ratio compared to the late ligation group.

• Left atrial to aortic root ratio was 1.97 in the early ligation group versus 1.74 in the late ligation group (P = .018).
• Despite this difference, PDA size and other echocardiographic parameters were comparable between groups.
• Baseline demographic characteristics including gestational age and birth weight were similar between groups.
• Early ligation group included 64 patients and late ligation group included 35 patients.

Late surgical ligation of PDA was associated with a significantly higher incidence of severe bronchopulmonary dysplasia compared to early ligation.

• Severe bronchopulmonary dysplasia occurred in 68.6% of the late ligation group versus 35.9% of the early ligation group (P = .003).
• The late ligation group also showed a trend toward longer mechanical ventilation duration.
• Early ligation was defined as surgical ligation at less than 2 weeks of life; late ligation was defined as at greater than 2 weeks of life.
• The study was retrospective and covered preterm infants less than 36 weeks gestational age treated between January 2014 and December 2024.

No significant differences were observed between early and late ligation groups in rates of other major complications or postoperative complications.

• Rates of intraventricular hemorrhage, necrotizing enterocolitis, vocal cord palsy, and post-ligation cardiac syndrome were not significantly different between groups.
• Postoperative complications specifically assessed included vocal cord palsy and post-ligation cardiac syndrome.
• The total study cohort consisted of 99 preterm infants (64 early, 35 late) who underwent surgical ligation.

Surgical ligation rate has decreased over time but remains a necessary treatment option for hemodynamically significant PDA unresponsive to or with contraindications for medical treatment.

• Management of PDA in preterm infants has been described as 'highly controversial.'
• Optimal timing of surgical ligation is still controversial and has no established guideline.
• Medical treatment contraindications or failure were the indications for surgical ligation in the study population.
• The study population included preterm infants less than 36 weeks gestational age.