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CLINICAL RESEARCH: TRANSCATHETER CLOSURE OF CONGENITAL DEFECT

Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects

Results and Cost-Effective Considerations in a Low-Income Country

Department of Pediatric Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Cardiovascular (UNICAR), Guatemala City, Guatemala

Manuscript received March 28, 2005; revised manuscript received May 27, 2005, accepted June 6, 2005.

^_* Reprint requests and correspondence: Dr. Vladimiro Vida, Department of Pediatric Cardiovascular Surgery, UNICAR, 9 Avenue, 8-00 zona 1, Guatemala City, 01011 Guatemala CA. (Email: vladimirovida{at}interfree.it).

OBJECTIVES: We compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala.

BACKGROUND: The percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure.

METHODS: We reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures.

RESULTS: Eighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. $3,329.50 ± $411.30 and U.S. $4,521.03 ± $429.71; p < 0.001, respectively). Cost of the device (U.S. $2,930.00) proved to be the main cause for this difference.

CONCLUSIONS: We confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective.

Abbreviations and Acronyms   ASD II = ostium secundum atrial septal defect   ASO = Amplatzer septal occluder   CHD = congenital heart disease   CPB = cardiopulmonary bypass   ICU = intensive care unit   UNICAR = Unidad de Cirugía Cardiovascular de Cardiovascular

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