Current Status of Patent Ductus Arteriosus Stenting: An International Practice Based Study

Patent ductus arteriosus (PDA) stenting has become an accepted alternative to the modified Blalock–Taussig–Thomas shunt (mBTTS) for duct-dependent pulmonary blood flow (DDPBF). However, several key aspects of practice, including prostaglandin (PGE) titration, antiplatelet therapy, access strategy, back-up planning, and hypoplastic left heart syndrome (HLHS) palliation, remain highly variable. We conducted an international web-based survey of interventional pediatric cardiologists. Domains included PGE management, antiplatelet therapy, platelet function testing, stent-length selection, ECMO and surgical back-up, carotid access, complication profile. A total of 138 respondents participated. PGE strategies varied widely: in single-source pulmonary blood flow, 40% used saturation-guided titration, and 29% routinely discontinued PGE; in dual-source circulation, 40% always discontinued PGE and 34% used titration-based strategies. Aspirin monotherapy (46%) and dual antiplatelet therapy (45%) were equally used; clopidogrel doses typically approximated 0.2 mg/kg/day. Platelet function testing was rarely used (19%). Stent-length selection relied on straight-line measurement in 41% and tortuous central-line measurement in 39%. ECMO support was never available in 35% of centers, selectively available in 23%, and always available in 21%. A surgeon was routinely on standby in 48%. Carotid access was used percutaneously by 45% and surgically by 24%. Complications encountered by operators at any stage during their performing these procedures included ductal spasm (87%), thrombosis (51%), LPA “shut-down” (36%), and ductal dissection (33%). Contemporary PDA-stent practice varies markedly across institutions, particularly regarding PGE management, antiplatelet therapy, technical strategy, and back-up planning. HLHS and interstage practices show similar heterogeneity. These findings support the need for multicenter registries and consensus recommendations.