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.

Keywords

• secundum ASD, comparison, Amplatzer septal occluder, surgery