Surgical Endoscopy

, Volume 22, Issue 7, pp 1643–1648

Thoracoscopic ligation versus coil occlusion for patent ductus arteriosus: A matched cohort study of outcomes and cost

Authors

    • Division of Pediatric SurgeryLucile Packard Children’s Hospital at Stanford University
    • Division of Pediatric SurgeryLucile Packard Children’s Hospital
  • Alexandra Mihailovic
    • Divisions of Cardiology (LB) and Pediatric Surgery (AM, JCL)The Hospital for Sick Children
  • Lee Benson
    • Divisions of Cardiology (LB) and Pediatric Surgery (AM, JCL)The Hospital for Sick Children
  • Paul F. Kantor
    • Divisions of Cardiology (PK) and Pediatric Surgery (PGF, JMW, BHC)McMaster Children’s Hospital
  • Peter G. Fitzgerald
    • Divisions of Cardiology (PK) and Pediatric Surgery (PGF, JMW, BHC)McMaster Children’s Hospital
  • J. Mark Walton
    • Divisions of Cardiology (PK) and Pediatric Surgery (PGF, JMW, BHC)McMaster Children’s Hospital
  • Jacob C. Langer
    • Divisions of Cardiology (LB) and Pediatric Surgery (AM, JCL)The Hospital for Sick Children
  • Brian H. Cameron
    • Divisions of Cardiology (PK) and Pediatric Surgery (PGF, JMW, BHC)McMaster Children’s Hospital
Article

DOI: 10.1007/s00464-007-9674-1

Cite this article as:
Dutta, S., Mihailovic, A., Benson, L. et al. Surg Endosc (2008) 22: 1643. doi:10.1007/s00464-007-9674-1

Abstract

Background

Coil occlusion (CO) and video-assisted thoracoscopic surgery (VATS) have both emerged as minimal access therapies for patent ductus arteriosus (PDA). These techniques have not previously been statistically compared.

Methods

Twenty-four consecutive children undergoing VATS for PDA were each retrospectively matched by PDA diameter and child weight to two children undergoing CO (total 48) during the same time period. The two modalities were compared with respect to outcome and cost. Statistical analysis was performed using a Student’s t-test and Mantel–Haenszel relative risk. Cost analysis from an institutional perspective was used to compare resource consumption.

Results

Mean PDA diameter was 3.6 ± 1.2mm in both groups. Mean age and weight for VATS and CO children were 2.7 and 2.9 yrs and 13.2 and 13.1 kg, respectively. Mean surgical times were 94 ± 34 min for VATS and 50 ± 23 min for CO (p < 0.0001). Mean length of stay was 1.6 ± 0.2 days for VATS and 0.6 ± 0.2 days for CO (Mantel–Haenszel RR (95% CI) = 0.15 [0.07, 0.29], p < 0.0001). Mean fluoroscopy time with CO was 13 ± 7 min. No VATS or CO children required conversion to open surgical ligation. Two children in each arm (8% VATS, 4% CO) required indefinite antibiotic endarteritis prophylaxis for a persistent shunt. The cost per child was C$ 4282.80 (Canadian dollars) for VATS and C$ 3958.08 for CO.

Conclusions

VATS is as efficacious for PDA closure as CO but requires longer surgical times and lengths of stay. Costs for each procedure are similar.

Keywords

Patent ductus arteriosusCoil occlusionCoil embolizationVideo-assisted thoracoscopic surgeryVATSPediatric

Copyright information

© Springer Science+Business Media, LLC 2007