Beyond the Evidence: Psychological and Institutional Factors Shaping Patent Ductus Arteriosus Stent Adoption.

In infants with ductal dependent pulmonary blood flow (DDPBF), clinicians face a critical choice between two interventions to secure stable pulmonary circulation: the Blalock-Taussig-Thomas (BTT) shunt and patent ductus arteriosus (PDA) stenting. While the BTT shunt has long been the standard palliative procedure, its risks have prompted interest in less invasive alternatives. This manuscript explores the psychological and institutional factors contributing to the growing preference for PDA stenting over surgical shunting in the management of DDPBF. Cognitive biases, public reporting of surgical outcomes, and family preferences significantly influence clinicians' procedural decisions. Understanding these influences is essential to align clinical decisions with evidence-based practices, ensuring optimal care for patients while maintaining transparency and equity in procedural evaluation.