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[Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure]
1Centre chirurgical Marie-Lannelongue, Le Plessis-Robinson.
Insights
Transcatheter closure of patent ductus arteriosus offers comparable safety to surgery with lower morbidity and better patient comfort. While initial costs are higher, long-term results support it as a viable alternative.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Surgery
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Surgical closure has been the traditional treatment, but carries risks.
- Transcatheter closure offers a less invasive alternative.
Purpose of the Study:
- To compare clinical outcomes and costs of transcatheter versus surgical PDA closure.
- To evaluate safety, efficacy, and morbidity of both methods.
- To assess long-term results at 3 years.
Main Methods:
- A comparative study of 80 patients (40 transcatheter, 40 surgical).
- Evaluation of residual shunt rates, complications, and hospital stay.
- Cost analysis including direct and average costs.
Main Results:
- Transcatheter closure had a 9% residual shunt rate at 3 years; surgery had none.
- Morbidity was significantly lower with transcatheter closure.
- Average cost was lower with transcatheter closure (38,558 francs vs. 11,240 francs).
- Direct cost was higher for transcatheter closure due to prosthesis price.
Conclusions:
- Transcatheter closure is a safe and effective alternative to surgery for PDA.
- It offers reduced morbidity and improved patient comfort.
- Cost-effectiveness is favorable despite higher initial procedure cost.
Abstract:
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 regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.