TRANSCATHETER CLOSURE OF PATENT DUCTUS-AR TERIOSUS - COMPARISON OF RESULTS AND COSTS WITH SURGICAL CLOSURE

The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital . After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regres sed after transcatheter ablation of the prosthesis. After surgical clo sure, there were no residual shunt. Some postoperative complications w ere observed in 20% of cases, usually benign (ventilatory problems, dy sphonia or urinary infection), but occasionally more serious (peropera tive lesion of the pulmonary artery). Morbidity, inherent to the techn ique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was m uch less with transcatheter closure 38 558 francs versus 11 240 francs . On the other hand, the direct cost of transcatheter closure was grea ter than that of surgery : 32 798 francs versus 20 903 francs, the dif ference being related to the actual price of the prosthesis. The autho rs conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alterna tive to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure f or an increase in cost of the initial procedure which should decrease in relaton to the types and prices of the prosthesis used.