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.
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References
Radtke W (1998) Current therapy of the patent ductus arteriosus. Curr Opin Cardiol 13:59–65
Gross R, Hubbard J (1939) Surgical ligation of a patent ductud arteriosus. Report of a first successful case. JAMA 112:729–731
Mavroudis C, Backer C, Gevitz M (1994) Forty-six years of patent ductus arteriosus division at Children’s Memorial Hospital of Chicago: Standards for comparison. Ann Surg 220:402–409
Jaureguizar E, Vazquez J, Murcia J, Diez Pardo JA (1985) Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg 20:511–514
Westfelt JN, Nordwall A (1991) Thoracotomy and scoliosis. Spine 16:1124–1125
Schneider DJ, Moore JW (2006) Patent ductus arteriosus. Circulation 114:1873–1882
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 112:1634–1638; discussion 1638–1639
Singh TP, Morrow WR, Walters HL, Vitale NA, Hakimi M (1997) Coil occlusion versus conventional surgical closure of patent ductus arteriosus. Am J Cardiol 79:1283–1285
Portsmann W, Wierny L, Warnake H, Gerstberger G, Romaniuk P (1971) Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy. Radiol Clin North Am 9:203–218
Justino H, Justo R, Ovaert C, Magee A, Lee K, Hashmi A, Nykanen D, McCrindle B, Freedom R, Benson L (2001) Comparison of two transcatheter closure methods of persistently patent arterial duct. Am J Cardiol 87:76–81
Rothman A, Lucas VW, Sklansky MS, Cocalis MW, Kashani IA (1997) Percutaneous coil occlusion of patent ductus arteriosus. J Pediatr 130:447–454
Fadley F, al Halees Z, Galal O, Kumar N, Wilson N (1993) Left pulmonary artery stenosis after transacatheter occlusion of persistent arterial duct (lett). Lancet 341:559–560
Laborde F, Noirhomme P, Karam J, Batisse A, Bourel P, Saint Maurice O (1993) A new video-assisted thoracoscopic surgical technique for interruption of patient ductus arteriosus in infants and children. J Thorac Cardiovasc Surg 105:278–280
Rothenberg S, Chang J, Toews W, Washington R (1995) Thoracoscopic closure of patent ductus arteriosus: A less traumatic and more cost-effective technique. J Pediatr Surg 30:1057–1060
Burke RP, Jacobs JP, Cheng W, Trento A, Fontana GP (1999) Video-assisted thoracoscopic surgery for patent ductus arteriosus in low birth weight neonates and infants. Pediatrics 104:227–230
Hines M, Bensky A, Hammon J, Pennington D (1998) Video-assisted thoracoscopic ligation of patent ductus arteriosus: safe and outpatient. Ann Thorac Surg 66:853–859
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 5:57–59
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 25:387–393
Krichenko A, Benson LN, Burrows P, Moes CA, McLaughlin P, Freedom RM (1989) Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 63:877–880
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 76:1421–1427; discussion 1427–1428
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 76:1417–1420; discussion 1420
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Dutta, S., Mihailovic, A., Benson, L. et al. Thoracoscopic ligation versus coil occlusion for patent ductus arteriosus: A matched cohort study of outcomes and cost. Surg Endosc 22, 1643–1648 (2008). https://doi.org/10.1007/s00464-007-9674-1
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DOI: https://doi.org/10.1007/s00464-007-9674-1