Pediatric Cardiology

, Volume 33, Issue 2, pp 316–321 | Cite as

Comparison of Long-Term Clinical Outcomes and Costs Between Video-Assisted Thoracoscopic Surgery and Transcatheter Amplatzer Occlusion of the Patent Ductus Arteriosus

  • Haiyu Chen
  • Guoxing Weng
  • Zhiqun Chen
  • Huan Wang
  • Qi Xie
  • Jiayin Bao
  • Rongdong Xiao
Original Article


The current study was designed to compare long-term clinical outcomes and costs between video-assisted thoracoscopic surgery (VATS) and transcatheter Amplatzer occlusion (TAO). This study enrolled 294 patients with isolated patent ductus arteriosus (PDA) from April 2002 to April 2007, and 290 of these patients were followed up until April 2010. Of the 294 patients, 196 underwent VATS and 98 accepted TAO for PDA closure. The two groups were similar in terms of demographics and preoperative clinical characteristics. No cardiac deaths occurred in either group. All the patients in the VATS group had successful PDA closure, and 94 patients (94/98, 95.9%) in the TAO group had successful PDA occlusion. The incidence of acute procedure-related complications recorded was 1.5% in the VATS group compared with 10.2% in TAO group (P < 0.05). The cost per patient was $1,309.40 ± $312.20 in the VATS group and $3,415.80 ± $637.30 in the TAO group (P < 0.05). There were no cardiac deaths or newly occurring arrhythmias in either group during the fellow-up period. Up to the latest follow-up, no late recanalization or residual shunting was documented, and heart structure returned to normal level in the VATS group. However, residual shunting was detected in four more TAO patients. This study confirmed the long-term safety and efficacy of VATS clipping of PDA. Compared with TAO, PDA interrupted with VATS can achieve both excellent clinical results and satisfying cost effectiveness. The cost for VATS is only a little more than one third the cost for TAO.


Intervention Patent ductus arteriosus Video-assisted thoracic surgery 


  1. 1.
    Bensky AS, Raines KH, Hines MH (2000) Late follow-up after thoracoscopic ductal ligation. Am J Cardiol 86:360–361PubMedCrossRefGoogle Scholar
  2. 2.
    Bilkis AA, Alwi M, Hasri S, Haifa AL, Geetha K, Rehman MA, Hasanah I (2001) The Amplatzer duct occluder: experience in 209 patients. J Am Coll Cardiol 37:258–261PubMedCrossRefGoogle Scholar
  3. 3.
    Chen ZY, Wu LM, Luo YK, Lin CG, Peng YF, Zhen XC, Chen LL (2009) Comparison of long-term clinical outcome between transcatheter Amplatzer occlusion and surgical closure of isolated patent ductus arteriosus. Chin Med J 122:1123–1127PubMedGoogle Scholar
  4. 4.
    Chen HY, Weng GX, Chen ZQ, Wang H, Xie Q, Bao JY, Xiao RD (2011) Comparison of posterolateral thoracotomy and video-assisted thoracoscopic clipping for the treatment of patent ductus arteriosus in neonates and infants. Pediatr Cardiol 32:386–390PubMedCrossRefGoogle Scholar
  5. 5.
    Eerola A, Jokinen E, Boldt T, Pihkala J (2006) The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function: a prospective study using two- and three-dimensional echocardiography and measurements of serum natriuretic peptides. J Am Coll Cardiol 47:1060–1066PubMedCrossRefGoogle Scholar
  6. 6.
    Gross R, Hubbard J (1939) Surgical ligation of a patent ductus arteriosus: report of a first successful case. JAMA 112:729–731CrossRefGoogle Scholar
  7. 7.
    Hawkins JA, Minich LL, Tani LY, Sturtevant JE, Orsmond GS, McGough EC (1996) Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus. J Thorac Cardiovasc Surg 112:1634–1639PubMedCrossRefGoogle Scholar
  8. 8.
    Hines MH, Raines KH, Payne RM, Covitz W, Cnota JF, Smith TE, O’Brien JJ, Ririe DG (2003) Video-assisted ductal ligation in premature infants. Ann Thorac Surg 76:1417–1420PubMedCrossRefGoogle Scholar
  9. 9.
    Jacobs JP, Giroud JM, Quintessenza JA, Morell VO, Botero LM, van Gelder HM, Badhwar V, Burke RP (2003) The modern approach to patent ductus arteriosus treatment: complementary roles of video-assisted thoracoscopic surgery and interventional cardiology coil occlusion. Ann Thorac Surg 76:1421–1428PubMedCrossRefGoogle Scholar
  10. 10.
    Jaureguizar E, Vazquez J, Murcia J, Diez Pardo JA (1985) Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg 20:511–514PubMedCrossRefGoogle Scholar
  11. 11.
    Jeong YH, Yun TJ, Song JM, Park JJ, Seo DM, Koh JK, Lee SW, Kim MJ, Kang DH, Song JK (2007) Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure. Am Heart J 154:436–440PubMedCrossRefGoogle Scholar
  12. 12.
    Laborde F, Noirhomme R, Karam J, Batisse A, Bourel P, Saint Maurice O (1993) A new video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus in infants and children. J Thorac Cardiovasc Surg 105:278–280PubMedGoogle Scholar
  13. 13.
    Masura J, Tittle P, Gavora P, Podnar T (2006) Long-term outcome of transcatheter patent ductus arteriosus closure using Amplatzer duct occluders. Am Heart J 151:755PubMedCrossRefGoogle Scholar
  14. 14.
    Nezafati MH, Mahmoodi E, Hashemian SH, Hamedanchi A (2002) Video-assisted thoracoscopic surgical (VATS) closure of patent ductus arteriosus: report of three-hundred cases. Heart Surg Forum 5:57–59PubMedGoogle Scholar
  15. 15.
    Nezafati MH, Soltani G, Vedadian A (2007) Video-assisted ductal closure with new modifications: minimally invasive, maximally effective, 1,300 cases. Ann Thorac Surg 84:1343–1348PubMedCrossRefGoogle Scholar
  16. 16.
    Pass RH, Hijazi Z, Hsu DT, Lewis V, Hellenbrand WE (2004) Multicenter USA Amplatzer patent ductus arteriosus occlusion device trial: initial and one-year results. J Am Coll Cardiol 44:513–519PubMedCrossRefGoogle Scholar
  17. 17.
    Portsmann W, Wierny L, Warnake H, Gerstberger G, Romaniuk PA (1971) Catheter closure of patent ductus arteriosus. 62 cases treated without thoracotomy. Radiol Clin North Am 9:203–218Google Scholar
  18. 18.
    Schneider DJ, Moore JW (2006) Patent ductus arteriosus. Circulation 114:1873–1882PubMedCrossRefGoogle Scholar
  19. 19.
    Vanaamo K, Berg E, Kokki H, Tikanoja T (2006) Video-assisted thoracoscopic versus open surgery for persistent ductus arteriosus. J Pediatr Surg 41:1226–1229CrossRefGoogle Scholar
  20. 20.
    Villa E, Vanden Eynden F, Le Bret E, Folliguet T, Laborde F (2004) Paediatric video-assisted thoracoscopic clipping of patent ductus arteriosus: experience in more than 700 cases. Eur J Cardiothorac Surg 25:387–393PubMedCrossRefGoogle Scholar
  21. 21.
    Weng GX, Xie Q, Wang H, Qi J (2000) The interruption of patent ductus arteriosus with video-assisted thoracic operation: a comparison with the conventional tans-thoracic approach. Chin J Clin Thorac Cardiovasc Surg 7:160–161Google Scholar
  22. 22.
    Westfelt JN, Nordwall A (1991) Thoracotomy and scoliosis. Spine 16:1124–1125PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Haiyu Chen
    • 1
  • Guoxing Weng
    • 1
  • Zhiqun Chen
    • 1
  • Huan Wang
    • 1
  • Qi Xie
    • 1
  • Jiayin Bao
    • 1
  • Rongdong Xiao
    • 1
  1. 1.Department of Cardiovascular SurgeryFujian Provincial Hospital, Fujian Medical UniversityFuzhouPeople’s Republic of China

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