Transcatheter Patent Ductus Arteriosus Closure in Extremely Premature Infants: Transition to the Bedside

Extremely premature infants (<28 weeks' gestation) with hemodynamically significant patent ductus arteriosus (PDA) may require transcatheter PDA closure (TCPC) when medical therapy fails. Although TCPC is associated with improved respiratory outcomes over surgical ligation, its availability is limited because of the need to transport these critically ill infants to cardiac catheterization laboratories, delaying care and increasing risk.

The authors describe the successful transition of TCPC from the catheterization laboratory to the neonatal intensive care unit (NICU) bedside, emphasizing feasibility, safety, and early outcomes.

The authors conducted a retrospective review of infants at <28 weeks' gestation weighing <2 kg who underwent TCPC between July 2012 and December 2024. The program evolved in 3 phases: traditional laboratory-based TCPC (2012-2021), laboratory-based TCPC using transthoracic echocardiographic guidance only (July to December 2021), and bedside TCPC in the NICU (2022-2024).

Of 500 infants, 176 underwent bedside TCPC. These infants were younger (median 20 days vs 29 days) and smaller (820 g vs 1,010 g) than laboratory-treated infants. Bedside procedures were shorter (18 minutes vs 32 minutes) and had reduced radiation exposure (0.019 Gy × cm² vs 0.068 Gy × cm²; P < 0.001). Procedural success was 100% across all settings. Major complication rates were low (1.7%) and similar across settings. Follow-up (median 6.8 years) showed an 89% survival rate, no residual PDAs, and minimal late complications.

Bedside TCPC is a feasible, safe, and effective approach for managing PDA in extremely premature infants. It eliminates the need for interhospital transport, supports earlier intervention, and may improve outcomes. With appropriate training and experience, bedside TCPC has the potential to become the standard of care across NICUs.