Comparison of effectiveness and cost of patent ductus arteriosus device occlusion versus surgical ligation of patent ductus arteriosus.

Arif Zulqarnain,Muhammad Younas,Tariq Waqar,Touseef Asma,Mirza Ahmad Raza Baig,Ahsan Beg

doi:10.12669/pjms.324.10048

Abstract

Objectives:Comparison of effectiveness and cost of transcatheter occlusion of patent ductus arteriosus (PDA) with surgical ligation of PDA.Methods:This retrospective comparative study was conducted in the pediatric cardiology department of Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Data of 250 patients who underwent patent ductus arteriosus (PDA) closure either surgical or trans-catheter closure using SHSMA Occluder having weight >5 kg from April 2012 to October 2015 were included in this study. SPSS version 20 was used for data analysis. Quantitative variables were compared using independent sample t-test. Chi-square test and fishers exact was used for qualitative variables. P-value <0.05 was considered statistically significant.Results:There were one hundred and twenty (120) patients who underwent transcatheter occlusion of PDA using SHSMA occluder (PDA Device Group) and one hundred and thirty (130) patients who underwent surgical ligation of PDA (Surgical Group). Incidence of residual shunting was two (1.5%) in surgical group and 0 (0.0%) in PDA Device group for one month follow up period. There were 4 (3.1%) major complications in surgical group. The rate of blood transfusions were high in surgical group (p-value 0.04). Hospital stay time was significantly less in PDA Device group (P-value <0.001). Total procedural cost was 110695+1054 Pakistani rupees in PDA Device group and 92414+3512 in surgical group (p-value <0.001). The cost of PDA device closure was 16.52% higher than the surgical ligation of PDA. There was no operative mortality.Conclusion:The transcatheter closure of PDA is an effective and less invasive method as compared to the surgical ligation. There is a lower rate of complications and the cost is not much high as compared to surgical PDA ligation.

Highlights

The ductus arteriosus is responsible for carrying 55-60% of total fetal output during intrauterine life and is usually closed within 2 to 3 weeks of age after birth.[1]
patent ductus arteriosus (PDA) closure prevents the development of complications e.g. cardiac failure, pulmonary arterial hypertension and infections.[1,2,3,4]
Data of 250 patients who underwent patent ductus arteriosus (PDA) closure either surgical or transcutaneous closure from April 2012 to October 2015 with a follow up period of one month was retrieved from the data base system of cardiac surgery and pediatric cardiology department of the hospital

Summary

Introduction

The ductus arteriosus is responsible for carrying 55-60% of total fetal output during intrauterine life and is usually closed within 2 to 3 weeks of age after birth.[1]. Surgical ligation of PDA was 1st described in 1930s through lateral thoracotomy with good results.[5] From past two decades, closure of PDA with latest generation devices has been performed with very good results in various age groups.[6] PDA closure with Amplatzer duct occluder (ADO) has proved an excellent therapeutic option.[7,8,9,10] The high cost of this device and other devices as compared to surgical ligation of PDA has limited their widespread use. Sun WF et al, have shown excellent outcomes of PDA closure using the SHSMA occlude.[11] This occluder is very cheap in price as compared to the ADO and other devices. We do not find any trial comparing the cost and effectiveness of SHSMA occluder versus surgical ligation. We planned this study to compare the cost difference and effectiveness of Transcatheter PDA closure using SHSMA occluder versus surgical ligation of PDA in a tertiary care center

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Results

Conclusion