COST AND EFFICACY OF SURGICAL LIGATION VERSUS TRANSCATHETER COIL OCCLUSION OF PATENT DUCTUS-ARTERIOSUS

Objective: The purpose of this study was to compare cost and efficacy of surgical closure of patent ductus arteriosus using new critical pat hway methods with outpatient transcatheter coil occlusion of patent du ctus arteriosus, Methods: Surgical techniques included a transaxillary , muscle-sparing thoracotomy, triple ligation of the patent ductus art eriosus, no chest tube, and discharge from the hospital within 24 hour s, Transcatheter coil occlusion of patent ductus arteriosus was done a s an outpatient procedure, Costs were compared with inclusion of all h ospital and professional charges, Results: From July 1994 until March 1996, 20 patients underwent coil occlusion of patent ductus arteriosus and 20 patients underwent surgical closure of patent ductus arteriosu s. Duration of hospitalization was significantly less for the patients receiving coil occlusion (11 +/- 6 hours) as compared with that for t he patients having surgical ligation (28 +/- 7 hours, p < 0.05), Total charges were similar for surgical ligation ($7101 +/- $408) as compar ed with those for coil occlusion ($7104 +/- $886, p > 0.05), Morbidity in coil occlusion included inability to occlude the patent ductus art eriosus in two patients (2/20, 10%) and residual patency in two patien ts (2/18, 11%), Morbidity in the surgical group included nausea and vo miting necessitating hospitalization for more than 36 hours in one pat ient (1/20, 5%), transient left recurrent laryngeal nerve palsy in one (1/20, 5%), and pneumothorax in two patients (2/20, 10%), There were no instances of residual patency in the surgical group, Conclusions: T ransaxillary thoracotomy without tube thoracostomy and with critical p athway methods allows safe and effective ligation of a patent ductus a rteriosus with early hospital discharge. This surgical method has simi lar cost, higher efficacy rate, and applicability in all patients as c ompared with newer transcatheter coil occlusion techniques for closure of a patent ductus arteriosus.