Percutaneous device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect.

Abstract

BACKGROUND:

Percutaneous device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect (pmVSD) are two typical methods to reduce the invasiveness of the conventional operation through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost.

METHODS:

Inpatients with isolated pmVSD who had undergone percutaneous device occlusion or minimally invasive surgical repair from June 2009 to June 2012 were reviewed for a comparative investigation between the two procedures.

RESULTS:

Procedure success was achieved in 80 percutaneous (93.0%) and in 113 surgical (98.3%) procedures (p=0.076). Percutaneous patients were older, with a smaller VSD size than surgical patients (16±11.7 vs 3.8±2.4 mm, p<0.001; 4.0±1.2 vs 4.3±1.3 mm, p=0.034, respectively). Major complications occurred in 1 percutaneous (1.2%) and in 4 surgical (3.5%) procedures (p=0.602), and minor complications occurred in 27 percutaneous (33.3%) and in 37 surgical (32.2%) procedures (p=0.991). The surgical repair cost 31% less than the device occlusion (¥20,565±¥3,497 vs ¥29,795±¥2,643, p<0.001), where most of the cost was attributed to the occluder in the amount of ¥19,500.

CONCLUSIONS:

Compared with device occlusion, minimally invasive surgical repair can provide comparable efficacy and complication rates. In addition, it is 31% cheaper than device occlusion. In low-income countries where health care resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.

• Authors: Zhao Yang Chen, Bing Ru Lin, Wan Hua Chen, Qiang Chen, Xiu Fen Guo, Liang-Long Chen, Jun Bo Ge
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 97 Issue 4 Pg. 1400-6 (Apr 2014) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 24594210 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Cardiac Surgical Procedures (economics, instrumentation, methods)
• Child
• Child, Preschool
• Costs and Cost Analysis
• Female
• Heart Septal Defects, Ventricular (economics, surgery)
• Humans
• Infant
• Male
• Minimally Invasive Surgical Procedures
• Septal Occluder Device (economics)
• Treatment Outcome