Transcatheter vs. surgical closure of patent ductus arteriosus: outcomes and cost analysis
Keywords:
persistent ductus arteriosus, Amplatzer® duct occluder, surgical ligation, cost analysis
Abstract
Background Patent ductus arterious (PDA) is a non-cyanoticcongenital 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.
References
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Nadas pediatric cardiology. Boston: Hanley & Belfus.Inc;
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2. Hoffman JIE, Kaplan S. The incidence of congenital heart
disease. J Am Coll Cardiol. 2002;39:890-900.
3. Musewe NN, Olley PM. Patent ductus arteriosus. In:
Freedom RM, Benson LN, Smallhom JF, editors. Neonatal
heart disease. London: Springer-Verlag London; 1992. p.
593-609.
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Circulation. 2006;114:1873-82 .
5. Lloyd TR, Beekman RH. Transcatheter closure of atrial
septa! defect and patent ductus arteriosus. In: Topol EJ,
editor. Texbook of interventional cardiology. 2nd edition.
Philadelphia: WB Saunders; 1994. p. 298-338.
6. Rigby ML. Closure of the arterial duct: past, present, future.
Heart. 1996;76:46 1-2.
7. Overmeire BY, Smets K, Lecoutere D, De Broek H, Weyler
J, De Groote K, et al. A comparison of ibuprofen and
indomethacin for closure of patent ductus erteriosus. N Engl
J Med. 2000;343:674-81.
8. DontiA, Formigari R, Bonvicini M, Prandstraller D, BronzettiG. Transcatheter closure of the patent ductus arteriosus with
new-generation devices: comparative data and follow-up
results. Ital Heart J. 2002;3: 122-7.
9. Bilkis AA, Alwi M, Harsi S, Haifa AL, Geetha K, Rehman
MA. The Amplatzer duct occluder: experience in 209
patients. J Am Coll Cardiol. 2001 ;37:258-61.
10. Wong KT, Chau AKT, Cheung YF, Yung TC, Lun KS.
Midterm results of transcatheter closure of moderate to
large-sized patent ductus arteriosus using the Amplatzer duct
occluder. HK J Pediatr. 2005;10:245-50.
11. Masura J, Walsh KP, Thanopoulous B, Chan C, Bass J,
Goussous Y, et al. Catheter closure of moderate to large
sized patent ductus arteriosus using the new Amplatzer
duct occluder: immediate and short-term result. J Am Coll
Cardiol. 1998;31:878-82.
12. Djer MM, Putra ST, Noormanto, Tobing T, Sukardi R,
Sastroasmoro S. Transcatheter closure of patent ductus
arteriosus: a two-year experience at Cipto Mangunkusumo
hospital, Jakarta. Ind J Pediatr Cardiol. 2004;1 :61-2.
13. Mavroudis C, Backer CL, Gevitz M. Forty-six years of
patent ductus arteriosus division at Children's Memorial
Hospital of Chicago. Standards for comparison. Ann Surg.
1994;220:402-9.
14. Darbari A, Chandra G, Gupta A, Kumar A, Bharadwaj M,
Tandon S. Clinical outcomes and experiences with transaxillarysurgical
ligation of patent ductus arteriosus. Ind J
Thorac Cardiovasc Surg. 2007;23:197-201.
15. Zucker N, Qureshi SA, Baker EJ, Deverall PB, Tynan M.
Residual patency of the arterial duct subsequent to surgical
ligation. Cardiol Young. 1993 ;3: 216- 9.
16. Prieto LR, De Camillo DM, Konrad DJ, Longworth LS,
Latson LA. Comparison of cost and clinical outcome between
transcatheter coil occlusion and surgical closure of isolated
patent ductus arteriosus. J Pediatr. 1998;101:1020-4.
244 • Paediatr lndones, Vol. 53, No. 4, July 2013
17. Fedderly R, Beekman RH, Mosca RS. Comparison of hospital
charges for closure of patent ductus arteriosus by surgery and
by transcatheter coil occlusion. Am J Cardiol. 1996;77:776-
9.
18. Torgerson D, Campbell M. Cost effectiveness calculations
and sample size. BMJ. 2000;321:696-7.
19. Fischer G, Stieb J, Uebing A, Grabitz R, Kramer HH.
Transcatheter closure of persistent ductus arteriosus in infants
using the Amplatzer duct occluder. Heart J. 2001;86:444-
7.
20. Human DC, McIntyre L, Gniewek A, HannaBD. Technology
assessment of nonsurgical closure of patent ductus arteriosus:
an evaluation of the clinical effectivenessand costs of a new
medical device.Pediatrics.1995 ;96; 703-6.
21. Masura J, Tittel P, Gavora P, Podnar T. Long-term outcome
of transcatheter patent ductus arteriosus closure using
Amplatzer duct occluders. Am Heart J. 2006;151:755.e7-
10.
22. Pass RH, Hijazi Z, Hsu DT, Lewis V, Hellenbrand WE.
Multicenter USA Amplatzer patent ductus arteriosus
occlusion device trial: initial and one-year results. J Am Coll
Cardiol. 2004;44:513-9.
23. Demir T, Oztunc,; F, (:etin G, Saltik L, Eroglu AG, Babaoglu
K, et al. Patency or recanalization of the arterial duct after
surgical double ligation and transfixion. Cardiol Young.
2007;17:48-50.
24. Gray DT, Weinstein MC. Decision and cost-utility analyses
of surgical versus transcatheter closure of patent ductus
arteriosus: should you let a smile be your umbrella. Med
Decis Making. 1998;18:187-201.
25. Hughes ML, Maskell G, Goh TH, WilkinsonJL. Prospective
comparison of costs and short term health outcomes of
surgical versus device closure of atrial defect in children.
Heart. 2002;88:67-70.
Nadas pediatric cardiology. Boston: Hanley & Belfus.Inc;
1992. p. 598-608.
2. Hoffman JIE, Kaplan S. The incidence of congenital heart
disease. J Am Coll Cardiol. 2002;39:890-900.
3. Musewe NN, Olley PM. Patent ductus arteriosus. In:
Freedom RM, Benson LN, Smallhom JF, editors. Neonatal
heart disease. London: Springer-Verlag London; 1992. p.
593-609.
4. Schneider DJ, Moore JW. Patent ductus arteriosus .
Circulation. 2006;114:1873-82 .
5. Lloyd TR, Beekman RH. Transcatheter closure of atrial
septa! defect and patent ductus arteriosus. In: Topol EJ,
editor. Texbook of interventional cardiology. 2nd edition.
Philadelphia: WB Saunders; 1994. p. 298-338.
6. Rigby ML. Closure of the arterial duct: past, present, future.
Heart. 1996;76:46 1-2.
7. Overmeire BY, Smets K, Lecoutere D, De Broek H, Weyler
J, De Groote K, et al. A comparison of ibuprofen and
indomethacin for closure of patent ductus erteriosus. N Engl
J Med. 2000;343:674-81.
8. DontiA, Formigari R, Bonvicini M, Prandstraller D, BronzettiG. Transcatheter closure of the patent ductus arteriosus with
new-generation devices: comparative data and follow-up
results. Ital Heart J. 2002;3: 122-7.
9. Bilkis AA, Alwi M, Harsi S, Haifa AL, Geetha K, Rehman
MA. The Amplatzer duct occluder: experience in 209
patients. J Am Coll Cardiol. 2001 ;37:258-61.
10. Wong KT, Chau AKT, Cheung YF, Yung TC, Lun KS.
Midterm results of transcatheter closure of moderate to
large-sized patent ductus arteriosus using the Amplatzer duct
occluder. HK J Pediatr. 2005;10:245-50.
11. Masura J, Walsh KP, Thanopoulous B, Chan C, Bass J,
Goussous Y, et al. Catheter closure of moderate to large
sized patent ductus arteriosus using the new Amplatzer
duct occluder: immediate and short-term result. J Am Coll
Cardiol. 1998;31:878-82.
12. Djer MM, Putra ST, Noormanto, Tobing T, Sukardi R,
Sastroasmoro S. Transcatheter closure of patent ductus
arteriosus: a two-year experience at Cipto Mangunkusumo
hospital, Jakarta. Ind J Pediatr Cardiol. 2004;1 :61-2.
13. Mavroudis C, Backer CL, Gevitz M. Forty-six years of
patent ductus arteriosus division at Children's Memorial
Hospital of Chicago. Standards for comparison. Ann Surg.
1994;220:402-9.
14. Darbari A, Chandra G, Gupta A, Kumar A, Bharadwaj M,
Tandon S. Clinical outcomes and experiences with transaxillarysurgical
ligation of patent ductus arteriosus. Ind J
Thorac Cardiovasc Surg. 2007;23:197-201.
15. Zucker N, Qureshi SA, Baker EJ, Deverall PB, Tynan M.
Residual patency of the arterial duct subsequent to surgical
ligation. Cardiol Young. 1993 ;3: 216- 9.
16. Prieto LR, De Camillo DM, Konrad DJ, Longworth LS,
Latson LA. Comparison of cost and clinical outcome between
transcatheter coil occlusion and surgical closure of isolated
patent ductus arteriosus. J Pediatr. 1998;101:1020-4.
244 • Paediatr lndones, Vol. 53, No. 4, July 2013
17. Fedderly R, Beekman RH, Mosca RS. Comparison of hospital
charges for closure of patent ductus arteriosus by surgery and
by transcatheter coil occlusion. Am J Cardiol. 1996;77:776-
9.
18. Torgerson D, Campbell M. Cost effectiveness calculations
and sample size. BMJ. 2000;321:696-7.
19. Fischer G, Stieb J, Uebing A, Grabitz R, Kramer HH.
Transcatheter closure of persistent ductus arteriosus in infants
using the Amplatzer duct occluder. Heart J. 2001;86:444-
7.
20. Human DC, McIntyre L, Gniewek A, HannaBD. Technology
assessment of nonsurgical closure of patent ductus arteriosus:
an evaluation of the clinical effectivenessand costs of a new
medical device.Pediatrics.1995 ;96; 703-6.
21. Masura J, Tittel P, Gavora P, Podnar T. Long-term outcome
of transcatheter patent ductus arteriosus closure using
Amplatzer duct occluders. Am Heart J. 2006;151:755.e7-
10.
22. Pass RH, Hijazi Z, Hsu DT, Lewis V, Hellenbrand WE.
Multicenter USA Amplatzer patent ductus arteriosus
occlusion device trial: initial and one-year results. J Am Coll
Cardiol. 2004;44:513-9.
23. Demir T, Oztunc,; F, (:etin G, Saltik L, Eroglu AG, Babaoglu
K, et al. Patency or recanalization of the arterial duct after
surgical double ligation and transfixion. Cardiol Young.
2007;17:48-50.
24. Gray DT, Weinstein MC. Decision and cost-utility analyses
of surgical versus transcatheter closure of patent ductus
arteriosus: should you let a smile be your umbrella. Med
Decis Making. 1998;18:187-201.
25. Hughes ML, Maskell G, Goh TH, WilkinsonJL. Prospective
comparison of costs and short term health outcomes of
surgical versus device closure of atrial defect in children.
Heart. 2002;88:67-70.
Published
2013-08-31
How to Cite
1.
Djer M, Mochammading M, Said M. Transcatheter vs. surgical closure of patent ductus arteriosus: outcomes and cost analysis. PI [Internet]. 31Aug.2013 [cited 13Nov.2024];53(4):239-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/289
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-08-31
Accepted 2016-08-21
Published 2013-08-31
