Comparison of Long-Term Clinical Outcomes and Costs Between Video-Assisted Thoracoscopic Surgery and Transcatheter Amplatzer Occlusion of the Patent Ductus Arteriosus
ABSTRACT The current study was designed to compare long-term clinical outcomes and costs between video-assisted thoracoscopic surgery (VATS) and transcatheter Amplatzer occlusion (TAO). This study enrolled 294 patients with isolated patent ductus arteriosus (PDA) from April 2002 to April 2007, and 290 of these patients were followed up until April 2010. Of the 294 patients, 196 underwent VATS and 98 accepted TAO for PDA closure. The two groups were similar in terms of demographics and preoperative clinical characteristics. No cardiac deaths occurred in either group. All the patients in the VATS group had successful PDA closure, and 94 patients (94/98, 95.9%) in the TAO group had successful PDA occlusion. The incidence of acute procedure-related complications recorded was 1.5% in the VATS group compared with 10.2% in TAO group (P < 0.05). The cost per patient was $1,309.40 ± $312.20 in the VATS group and $3,415.80 ± $637.30 in the TAO group (P < 0.05). There were no cardiac deaths or newly occurring arrhythmias in either group during the fellow-up period. Up to the latest follow-up, no late recanalization or residual shunting was documented, and heart structure returned to normal level in the VATS group. However, residual shunting was detected in four more TAO patients. This study confirmed the long-term safety and efficacy of VATS clipping of PDA. Compared with TAO, PDA interrupted with VATS can achieve both excellent clinical results and satisfying cost effectiveness. The cost for VATS is only a little more than one third the cost for TAO.
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ABSTRACT: To present a modified and safe technique of thoracoscopic clipping of patent ductus arteriosus (PDA) in children and its early outcomes. Patients are anesthetized, ventilated via single-lung ventilation, and placed in a right lateral position. The surgeon and the assistant stand at the patient's feet, and a monitor is placed at the patient's head. The ductus is pulled forward with a Vicryl(®) (Ethicon) thread and clipped completely. From May 2010 to February 2011, 58 patients with PDA (27 boys and 31 girls) were operated on using the same technique. Patients' ages varied from 8 days to 36 months. Mean weight of patients was 5.9±2.8 kg (range, 2.1-10 kg). Mean operative time was 33±12 minutes (range, 15-90 minutes). There were no intraoperative complications. Postoperative complications occurred in 2 patients: 1 patient developed a pneumothorax, and 1 patient had pleural effusion. Mean postoperative stay was 4.1±2.1 days for patients >3 months old and 11.9±8.4 days for patients ≤3 months old. No injuries of recurrent laryngeal nerve occurred in any patients, and there were no residual shunts in any patients 3-6 months after discharge. A modified technique of thoracoscopic closure is a safe and effective procedure for PDA in children.Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2012; 22(4):422-4. DOI:10.1089/lap.2011.0454 · 1.19 Impact Factor
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ABSTRACT: There is quite high risk of vascular complications connected with arterial puncture - mainly in the group of the smallest patients weighing less than 10 kg. To evaluate a new method of percutaneous closure of persistent arterial duct (PDA) in small children. Six patients were enrolled in this method of PDA closure at the age of 10.67 ±1.97 months. The mean weight was 8.85 ±0.66 kg. The occluders were implanted using only venous access. The position of the occluder was determined by angiography in the pulmonary artery through the delivery system and by echocardiography. The procedure was effective in all six cases but we managed to proceed in the planned transvenous method in five cases. There was one case of complete duct constriction after introduction of the catheter, so precise measurements were impossible. After removal of the catheter the constriction remitted completely. The duct was closed in the standard manner. During echocardiographic examination we found complete closure of all six arterial ducts directly after the procedures and in the follow-up (9.17 ±3.02 months). No stenosis within the pulmonary arteries or aorta were found. Transcatheter arterial duct occlusion without arterial puncture is an effective and safe method of treatment allowing one to reduce the complications connected with arterial puncture. A possible complication of this method may be a constriction of the duct walls as a result of a larger amount of manipulations.Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 06/2013; 9(2):132-5. DOI:10.5114/pwki.2013.35447 · 0.07 Impact Factor
Article: Patent ductus arteriosus.[Show abstract] [Hide abstract]
ABSTRACT: Patent ductus arteriosus in adults is usually an isolated lesion with a small to moderate degree of shunt, as a larger shunt becomes symptomatic earlier in childhood. The classic murmur of patent ductus arteriosus may be the first clue to its presence, or it may be detected accidently by transthoracic echocardiography, computed tomography, or magnetic resonance angiography for an unrelated condition. The percutaneous approach is safe and effective in more than 98% of patients. Subacute bacterial endocarditis prophylaxis is not indicated routinely except for 6 months following the closure percutaneously or surgically.Cardiology clinics 08/2013; 31(3):417-30. DOI:10.1016/j.ccl.2013.05.006 · 1.06 Impact Factor