Time trends and clinical outcomes of transcatheter patent ductus arteriosus closure in adults: insights from a Japanese nationwide registry.

Large-scale data on the current status, outcomes, and complications of transcatheter patent ductus arteriosus (PDA) closure in adults remain limited. This study aimed to elucidate the current status of transcatheter PDA closure in adults. Patient data (age ≥ 16 years) between January 2015 and December 2023 were extracted from the Japanese Structural Heart Disease (J-SHD) registry. We assessed the current practice of transcatheter PDA closure in Japan, focusing on the clinical characteristics, in-hospital mortality, intraoperative deaths, and adverse events. Procedural success was defined as appropriate device implantation without any adverse events. A total of 377 adult patients (median age, 65 years [interquartile range, 50-74 years]; 18.3% male) who underwent transcatheter PDA closure were included. Overall, 9.8% (n = 24) of the patients were New York Heart Association class III/IV. The most common comorbidities were hypertension (43.0%, n = 162), hyperlipidemia (16.7%, n = 63), and renal dysfunction (10.9%, n = 41). The median Qp/Qs ratio was 1.5 [1.3-1.8], and the median procedural time was 100 [65-120] minutes. The procedural success rate was 99.2% (n = 374). The rate of failed deployment was 0.3% (n = 1). No intraoperative deaths occurred, and complications were rare; 0.5% (n = 2) of the patients required emergency surgery. No hemorrhage requiring transfusion, vascular rupture, vessel obstruction, or contrast-induced nephropathy was observed after the procedures. Real-world data demonstrated that transcatheter PDA closure is safe and effective in adults. However, the high prevalence of comorbidities and the rare occurrence of emergency surgery underscore the need for careful postprocedural management.