Comparison of surgical vs. non-surgical closure procedures for secundum atrial septal defect
Abstract
Backgi-ound Surgery has been the standard therapy for secundum
atrial septa! defect (ASD) closure, but it has significant associated
morbidities related to st ernotomy, car diopulmonary bypass,
complications, residual scars, and trauma. A less invasive nonsurgical
approach with transcatheter devices was developed to
occlude ASD. Amplatzer® septa! occluder (ASO) is a common
device in transcatheter closure.
Objective To compare two secundum ASD closure procedures,
transcatheter closure by ASO and surgical closure, in terms of
efficacy, complications, length of hospital stay, and total costs.
Methods A retrospective analysis was performed on children
with secundum ASD admitted to the Cardiology Center of
Cipto Mangunkusumo Hospital from January 2005 to December
2011. Patients received either transcatheter closure with ASO
or surgical closure procedures. Data was obtained from patients'
medical records.
Results A total of 112 secundum ASD cases were included in this
study, consisting of 42 subjects who underwent transcatheter closure
procedure by ASO and 70 subjects who underwent surgical closure
procedure. Procedure efficacies of surgery and ASO were not significantly
different (98.6% vs 95.2%, respectively, P= 0.555). However,
subjects who underwent surgical procedures had significantly more
complication s than subjects who underwent transcatheter closure
procedure (60% vs 28.6%, respectively, OR 1.61; 95%CI 1.19 to
2.18; P= 0.001). Hospital stays were also significantly longer for
surgical patients than for transcatheter closure patients (6 days vs
2 days, respectively, P< 0.0001). In addition, all surgical subjects
required intensive care. Transcatheter closure had a mean total cost
of 52.7 (SD 6.7) million Rupiahs while the mean cost of surgery was
47 (SD 9.2) million Rupiahs (P< 0.0001) . Since the ASO device
cost represented 58% of the total cost of transcatheter closure, the
mean cost of transcatheter closure procedure without the device
itself was less costly than surgery.
Conclusion Transcatheter closure using ASO has a similar efficacy
to that of surgical closure procedure. However, subjects who
underwent transcatheter closure have lower complication rates
and shorter length ofhosp ital stays than subjects who had surgery,
but transcatheter closure costs are higher compared to the surgical
procedure.
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Accepted 2016-08-21
Published 2013-04-30
