Comparison of transvenous versus transthoracic catheter-based device closure of patent ductus arteriosus with amplatzer duct occluder.

OBJECTIVE: This study compared the clinical outcome of the transvenous versus transthoracic approach for closure of patent ductus arteriosus (PDA).

BACKGROUND: There are no data regarding the results of transvenous versus transthoracic catheter-based device closure of PDA with Amplatzer duct occluder (ADO) despite their increasing use as alternatives to conventional surgery.

METHODS: In this observational study, a total of 150 consecutive patients with PDA were allocated either to the transvenous approach (group A, n = 108) and the transthoracic approach (group B, n = 42) by using ADO between January 2010 and April 2012. Echocardiography was performed to evaluate the prespecified initial and 6-month success of PDA closure. The technical indices and procedure-related major acute and chronic complications were documented.

RESULTS: There were similar initial success rates (98.2% vs 100%; P>.05) and 6-month success rates (99.1% vs 100%; P>.05) between groups, and group A had fewer major acute complications (3.7% vs 85.7%; P<.001), shorter operating time (1.3 hours vs 2.1 hours; P<.001), Intensive Care Unit stay (0 hours vs 23.0 hours; P<.001), and recovery time (3.8 days vs 9.5 days; P<.001), and lower rates of general anesthesia (36.1% vs 100%; P<.001), blood transfusion (0.9% vs 71.4%; P<.001), and extra use of antibiotics (27.8% vs 78.6%; P<.001), and lower total cost of hospitalization ($3815.78 vs $5730.21; P<.001).

CONCLUSIONS: Despite similar efficacy for duct closure with ADO, transvenous approach was associated with fewer acute complications, more periprocedural comfort, and lower cost; thus, transthoracic approach should not be a reasonable choice for duct closure except for particular indications.