Transcatheter vs. surgical closure of patent ductus arteriosus: outcomes and cost analysis

• Main Authors: Mulyadi M Djer, Mochammading Mochammading, Mardjanis Said
• Format: Article
• Language: English
• Published: Indonesian Pediatric Society Publishing House 2013-08-01
• Series: Paediatrica Indonesiana
• Subjects: persistent ductus arteriosus, Amplatzer® duct occluder, surgical ligation, cost analysis
• Online Access: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/289
• ISSN: 0030-9311; 2338-476X

Background Patent ductus arterious (PDA) is a non-cyanotic congenital heart disease (CHD) caused by the patency of the arterial duct after birth. For the last three decades, management of PDA with transcatheter closure has been gaining popularity, including in developing countries. However its effectiveness in terms of clinical outcomes and cost may vary among center and has not been thoroughly evaluated yet in Indonesia. Objectives To compare the cost and clinical effectiveness of PDA closure using transcatheter approach compared to surgical ligation. Methods We performed a retrospective review on patients underwent either transcatheter or surgical closure of PDA between January 2000 and December 2006 in Cipto Mangunkusumo Hospital,Jakarta, Indonesia. Clinical outcomes as well as cost were compared using the student T-test and Chi-square for numerical and categorical variables, respectively Results During the study period, 89 patients underwent transcatheter closure using an Amplatzer® device occluder (ADO) device and 67 had surgical ligation. Successful PDA closure on first attempt was achieved in 87 (96%) and 63 (94%) children who underwent transcatheter and surgical closure, respectively (P = 1.000). Two children with unsuccessful transcatheter closure eventually had their PDA closed by surgery, whereas one child with residual PDA after surgical closure had his PDA closed by coil. No residual PDA was found in the transcatheter closure group at one-week follow up. Duration of hospitalization was significantly less for patients having transcatheter closure compared to surgery [2.7 (SD 1.5) vs. 6.6 (SD 1.5) days, P< 0.0001]. The cost for PDA closure with anAmplatzer® device was more expensive than surgical ligation [Rp. 29,930,000 (SD 57,200) vs. Rp. 12,205,000 (SD 89,300), P< 0.0001]. Conclusion Transcatheter closure is equally effective as surgical ligation in closing the PDA. Less hospitalization is required with transcatheter closure although the cost is higher than surgical ligation.