Optimal timing for transcatheter device occlusion of a hemodynamically significant patent ductus arteriosus in preterm infants: evidence, uncertainty, and future directions.

Transcatheter device occlusion is the primary method for definitive closure of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. While debate persists over expectant versus active medical management, a major knowledge gap remains regarding the optimal timing for transcatheter device occlusion when definitive closure is indicated. Pediatric and cardiovascular society statements recommend procedural intervention for high-volume, hsPDAs that persist beyond 10-14 days after failed conservative or pharmacologic therapy, or when pharmacotherapy is contraindicated. However, evidence guiding the precise timing of transcatheter device occlusion is limited and largely observational. It remains unclear how timing affects the prevention or reduction of neonatal morbidities while balancing procedural risks. Ongoing trials aim to provide more robust data. This review summarizes current evidence on timing of device closure in preterm infants, provides a clinical decision framework, highlights critical knowledge gaps, and outlines research priorities to inform individualized strategies that optimize outcomes.