WASHINGTON—The Society for Cardiovascular Angiography & Interventions (SCAI) has published a new position statement that provides best-practice guidance for the treatment of patent ductus arteriosus (PDA) using transcatheter occlusion (tcPDA) in premature infants. Published in JSCAI, "SCAI Position Statement on Transcatheter Occlusion of Patent Ductus Arteriosus in Premature Infants" offers a practical framework in four key areas:
- Patient selection criteria based on respiratory status, echocardiographic findings, and systemic perfusion indicators, with emphasis on collaborative decision-making among neonatologists, cardiologists, and families.
- Technical and procedural best practices for fragile premature neonates, including device selection, imaging, anesthesia, and complication prevention.
- Operator training benchmarks, suggesting specific case volumes for both trainees and practicing interventional cardiologists.
- Institutional infrastructure needs, such as neonatal-specific ventilation and thermoregulation equipment, advanced imaging, and pediatric cardiac surgical backup.
"This position statement represents a collective effort between neonatology, anesthesia, and interventional cardiology to provide comprehensive guidance on tcPDA device occlusion that can be adapted to the unique needs of each center and patient," said Brent M. Gordon, MD, FSCAI , chair of the writing committee and Professor of Pediatrics at Rady Children's Hospital, San Diego, CA. "While medications can close the PDA in about two-thirds of premature infants, the remaining third, as well as those requiring urgent closure, will still need a procedural intervention. Our aim is to help teams perform these interventions as safely and effectively as possible. By creating a team-based approach to these patients, we can standardize care, reduce complications, and give these infants the strongest possible start."
Transcatheter PDA closure has been a mainstay in congenital interventional cardiology for decades, but very low birth weight infants were once excluded due to access challenges and the lack of appropriately sized devices. In 2019, the U.S. Food and Drug Administration approved the first PDA occlusion device for infants as small as 700 grams, leading to rapid adoption of tcPDA in premature infants. Catheter-based closure has rapidly overtaken surgical ligation in many centers, producing encouraging early results. The position statement emphasizes that long-term success now hinges on consistent, high-quality implementation of procedure-specific best practices.
To that end, the statement reviews patient selection criteria and pre-procedural planning to help optimize patients for tcPDA. Potential complications are also reviewed, including tricuspid valve injury, cardiac perforation, and late-onset vessel obstruction. To address these risks, the authors stressed prevention through careful planning, early recognition during and after the procedure, and prompt intervention when needed. They recommend echocardiographic follow-up at 24 hours, one week, one month, three months, and six months post-procedure to detect and manage complications before they impact outcomes.
Further, the document outlines suggested operator training benchmarks to ensure physicians practicing tcPDA have adequate experience to prepare for and perform the procedure safely and effectively. Recognizing the need for specialized care, the document underscores the importance of regional referral networks and structured transport protocols to ensure infants are treated at centers with the necessary expertise and resources.
"Technological innovation has transformed how we treat premature infants with PDA, but technology alone is not enough," said Sarosh "Shawn" P. Batlivala, MD, MSci, FSCAI , co-chair of the writing committee and Professor, UC Department of Pediatrics, Cincinnati Children's Hospital Medical Center. "These procedures require meticulous planning, a deep understanding of neonatal physiology, and seamless coordination between every member of the care team. Our recommendations highlight not just how to perform the intervention, but how to prepare the patient, anticipate challenges, and provide the appropriate follow-up so these early successes translate into healthy long-term outcomes."
Looking ahead, the writing group called for ongoing quality improvement and expanded research to refine patient selection, optimize procedural techniques, and inform future device design. The authors encouraged institutions to contribute to national registries and maintain local databases to strengthen the evidence base and improve survival and quality of life for premature infants worldwide.
