Favorable Procedural Outcomes in Lower Versus Higher Weight Premature Infants Undergoing Transcatheter Patent Ductus Arteriosus Closure

Background Timing of device closure of patent ductus arteriosus (PDA) in preterm infants has been a topic of debate. Limited data exist comparing procedural outcomes based on infant weight at the time of the procedure. This study aimed to compare procedural outcomes and adverse events between premature infants weighing <2 kg and those weighing 2 to 5 kg undergoing PDA device closure. Methods We performed a retrospective review of premature infants (<37 weeks gestational age) who underwent transcatheter PDA closure at 2 institutions between 2013 and 2022. Patients were divided into 2 groups: group 1 (<2 kg) and group 2 (2-5 kg). Demographic characteristics, procedural characteristics, success rates, and adverse events were analyzed. Procedural success was defined as successful device placement with no more than small residual shunt and no device embolization within 24 hours. Results A total of 177 patients were included: 81 in group 1 (<2 kg) and 96 in group 2 (2-5 kg). Procedure success was significantly higher in group 1 than in group 2 (94% vs 83%, P = .031). Group 1 also had shorter median procedure time (50 vs 67 minutes, P = .002) and fluoroscopy time (6.4 vs 11.4 minutes, P < .0001). Adverse events occurred in 11.9% of patients, with a lower rate in group 1, but was not statistically significant (8.6% vs 14.6%, P = .22). No procedure-related mortality occurred. Conclusions Procedural outcomes of transcatheter PDA closure in premature infants are more favorable among smaller infants with higher success rates and fewer adverse events. Lower weight alone should not delay transcatheter PDA closure in preterm infants with hemodynamically significant PDA.