Transcatheter patent ductus arteriosus closure: what have we learned after over 25 years? A single-center experience with 1036 patients.

BACKGROUND: Transcatheter patent ductus arteriosus (PDA) closure has become the first method of treatment in the majority of patients; however, the device selection remains an open question.

AIMS: To analyze peri-procedural and one-year outcomes of PDA transcatheter closure with different devices throughout over a 25-year period at a single center.

METHODS: All 1036 patients who underwent transcatheter PDA closure from 1993 to 2020 were included in retrospective analysis. Different devices were used: Rashkind device (RD, n = 25); coils (n = 469); nitinol duct occluders type I (DO I, n = 300), II (n = 32), II additional sizes (ADO II AS, n = 209), and off-label devices: vascular plugs, atrial septal and muscular VSD occluders (n = 17). Data on 24-hour and one-year follow-up was available for 100% and 78.9% of patients, respectively.

RESULTS: The procedure was successful in 98.6% of patients with major complication rate of 0.2%. Complete PDA closure after a year was observed in 81.8% of RD, 93.7% of coils and 100% of duct occluders. There were no differences between Amplatzer DO I (n = 159) and its Chinese-made DO I copies (n = 141) in regards to success, efficacy and complication rates. Recently, ADO II AS has replaced coils and become the preferred device to close small-to-moderate PDA.

CONCLUSIONS: Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at one-year follow-up. Due to higher efficacy, ADO II AS has replaced coils to treat smaller PDA.