I think that after prostraglandin started to sustain the duct patent, the stent implantation in the arterial duct in a few days-old baby with bad clinical status and low weight is a good conduct.
It depends on the experience of the center (cardiologists) and the anatomy of the duct. Surgical shunts are not free from complications (postoperative infection, effusion, sudden thrombosis and obstruction) and as such alternatives can be interesting. Certainly in those patients with a rather straigthforward duct originating from the usual position and not too tortuous, stenting can be a safe and rather simple thing to do with astable result over the months following. Experience of the operator, however is important since the choice of the length of the stent is very important to avoid premature re-intervention due to ductal constriction at the pulmonary end of the duct or interference with aortic flow. In long and tortuous stents with a different angled origin, stenting is far more difficult, needing different approaches (axillary or carotid), different stents (longer or more flexible) or more than one stents. In these cases surgical shunts probably still remain the treatment of choice.
The most important thing to remember is that nor ductal stenting, nor surgical shunting is a simple routine intervention and should only be carried out by experienced operators.
I agree that the center experience plays a crucial role PDA stenting needs to be properly prepared to guard against stent thrombosis which is usually fatal. in our center we use to put the neonate on double antiplatelets nevertheless a considerable number experienced fatal stent thrombosis in the immediate and short term period post stent deployment
With regards to outcome and charge, stenting is preferred to shunt if experienced pediatric cardiac interventionists is available in the center.