Ja. Hawkins et al., COST AND EFFICACY OF SURGICAL LIGATION VERSUS TRANSCATHETER COIL OCCLUSION OF PATENT DUCTUS-ARTERIOSUS, Journal of thoracic and cardiovascular surgery, 112(6), 1996, pp. 1634-1638
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.