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.