Background Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. Methods A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity‐score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post‐procedure and the time taken for return to pre‐procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. Results Eighty ELBW infants (median procedure weight: 1060 [range 640–2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650–1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre‐procedural scores post‐SLP compared to post‐TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30‐days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2–9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5–4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. Conclusions TCPC is feasible in infants as small as 640‐2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.

Objective Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. Design The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. Setting A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Patients To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure‐related complications. Interventions It is important that specific techniques with venous‐only approach outlined in this article be followed to achieve optimal results with low risk of complications. Outcome measures This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. Results There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure‐related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. Conclusions It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.

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