Master of Public Health in Epidemiology

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    TREND, AND IMMEDIATE OUTCOMES OF TRANSCATHETER CLOSURE VERSUS SURGICAL LIGATION OF PDA IN CHILDREN WHO UNDERGONE CLOSURE OF PDA AT THE CARDIAC CENTER OF ETHIOPIA FROM 2012 TO 2022: COMPARATIVE CROSS-SECTIONAL STUDY.
    (hawassa universty, 2023-10) MOHAMMED NASIR
    Background: The Ductus arteriosus is an important fetal structure that helps in reducing right ventricular afterload during fetal life, but the patent ductus arteriosus (PDA) often closes spontaneously after birth. To prevent complications from patent ductus arteriosus, transcatheter closure (TC)and surgical ligation (SL) are management options for PDA that have not spontaneously closed. TC is preferred nowadays in older children and adults and SL in infants. However, the magnitude of the complications and outcomes associated with transcatheter closure (TC) and surgical ligation (SL) of PDA vary across studies. In this study, the trend, and immediate outcomes of TC of PDA versus SL of PDA were compared. Methodology:This study was conducted on children under 18 years ofage who underwent TC and SL of PDA at a cardiac center in Ethiopia (CCE) from January1, 2013, to January1, 2022, by retrospectively reviewingtherecords from February 1, 2022, to June 1, 2022.664 patients who underwent PDA closure, (n=316) in theTCgroup and (n=348) patients in the SL group were included in this study.Trend analysis was performed using theCochrane-Armitage test to test for linear trends. The propensity scoresmultivariable logistic regression model used in the mainanalysis considered the following variables:EchocardiographicPDAsize, age at diagnosis, age at surgery,gender, weight at surgery, height at surgery, and presence of severe pulmonary hypertension. Usingthe inverse probability of treatment weighting (IPTW) by propensity score and after adjusting for baseline variables, the Man U test, chi-square test, and Fisher's exact test were used to compare the complications and outcomes of SL and TC of PDA. Results: There was a linear trend in both transcatheter closure and surgical ligation of PDA. The SC-group patients were younger, lighter, and shorter and more proportion of patients had severe pulmonary hypertensionOverall complications were significantly higher with PDA surgical ligation compared with transcatheter closure ((112 (35.4%vs286 (71.9%)), p-value = 0.001)). Total mechanical ventilationtime, ICU stay, and hospital stay were higher in the surgical ligationgroup with ap-value of 0.001 each. vii | P a g e Conclusion: Transcatheter closure of PDA is a good and safe alternative to surgical ligation of PDA with reduced overall complication and shorter mechanical ventilation time, lower ICU stay, and lower hospital stay.