Venous-Only Approach for Transcatheter Patent Ductus Arteriosus Closure in Infants: Is It Time for Change?

BACKGROUND

The standard approach for transcatheter closure of patent ductus arteriosus (TC-PDA) requires arterial access and is associated with the risk of arterial injury, a metric tracked by national quality improvement registries. Venous-only TC-PDA in premature infants is performed successfully without arterial access. It was hypothesized that PDA closure in infants could be performed safely and effectively without arterial access.

METHODS

This is a single-center, retrospective, institutional review board-approved study. All infants weighing 2 to 10 kg who underwent TC-PDA closure between January 2019 and December 2024 were included in the study. Patients who underwent concurrent procedures and those with complex heart disease were excluded from the study. TC-PDA was performed using the standard approach or venous-only approach at the discretion of the attending cardiologist.

RESULTS

In total, 150 patients underwent TC-PDA: 59 patients (19 male) underwent closure using the standard approach and 91 patients (35 male) using the venous-only approach. There was no difference in the minimum patent ductus arteriosus diameter. There was no pulse loss in the venous-only cohort; 1 patient (1.7%) treated with the standard approach had clinical symptomatic arterial injury requiring therapy. The venous-only cohort was younger, weighed less, and had lower radiation exposure, contrast use, shorter total procedure, and total sheath time. There was no difference in other adverse procedural outcomes.

CONCLUSIONS

Venous-only approach for TC-PDA closure in infants is as effective and efficient as the standard approach. The added advantage of eliminating arterial injury increases the safety for TC-PDA in small infants.