Oclusão percutânea de comunicação interatrial pelo sistema único de saúde: uma opção economicamente viável

Abstract

A comunicação interatrial (CIA) é uma das malformações congênitas mais frequentes, representando aproximadamente 5% a 10% de todos os defeitos cardíacos congêni-tos. O tipo mais comum é a CIA ostium secundum (CIA OS), que representa cerca de 75% dessas malformações. Quando descoberta tardiamente ou na ausência de tratamento, além da alteração no exame clínico, pode existir insuficiên-cia cardíaca, arritmias cardíacas, insuficiência mitral, sobrecarga ventricular direita e hipertensão pulmonar. Em casos avançados com hipertensão pulmonar grave e reversão do shunt interatrial (direita para esquerda) instala-se a cianose, o que indica doença cardiopulmonar grave e mortalidade aumentada. Nas últimas décadas, com o aprimoramento das técnicas e dos dispositivos percutâneos, as possibilidades de tratamento dos defeitos congênitos por via percutânea têm crescido vertiginosamente. Vários estudos já demonstraram os excelentes resultados imediatos e a longo prazo da atriosseptoplastia percutânea. Além de proporcionar maior conforto ao paciente, menores taxas de complicações, menor tempo de recuperação intra e extra-hospitalar e eficácia similar à da atriosseptoplastia cirúrgica, em países desenvolvidos, é comprovadamente a opção mais econômica. Não há dúvidas de que, em futuro próximo, a relação custoefetividade desse procedimento será observada também em países em desenvolvimento como o Brasil, em que o custo da prótese, ainda hoje, é o principal obstáculo para a padronização desse procedimento, e em que os valores pagos pelos procedimentos cirúrgicos continuam muito defasados. DESCRITORES:Comunicação interatrial. Cardiopatias congênitas. Próteses e implantes. ABSTRACT Percutaneous Closure of Atrial Septal Defects by the Brazilian Health System: an Economically Feasible OptionAtrial septal defect (ASD) is one of the most frequent congenital malformations, representing 5% to 10% of all congenital heart defects. The most common type is the ostium secundum ASD (OS ASD), and represents 75% of these malformations. When diagnosed late or left untreated, in addition to abnormalities in the clinical examination, there may be heart failure, cardiac arrhythmias, mitral insufficiency, right ventricular overload and pulmonary hypertension. In advanced cases with severe pulmonary hypertension and interatrial shunt reversal (right to left), there is cyanosis, which indicates severe cardiopulmonary disease and increased mortality. In the last decades, with the improvement of percutaneous techniques and devices, the possibility of percutaneous treatment of congenital defects has increased dramatically. Several studies have shown excellent early and long-term results of percutaneous atrial septoplasty. In addition to providing greater comfort for patients, lower complication rates, less in-hospital and extra-hospital recovery time and efficacy similar to that of surgical atrial septoplasty in developed countries, it is definitely the most economic option. There is no doubt that in the near future, the cost-effectiveness ratio of this proc...

Perfil de pacientes com cardiopatia congênita submetidos a procedimentos percutâneos em um centro terciário: análise de 1.002 casos

“…Moreover, percutaneous VSD closure is not yet a reality for the patients attended to at the Brazilian Unified Health System (Sistema Único de Saúde -SUS). 7 The present results demonstrated that the congenital heart disease diagnosis was made predominantly in the postnatal period, among 1 to 5 years aged children. During this period, a congenital heart disease diagnosis is obtained more frequently, and most percutaneous therapeutic procedures are performed.…”

“…11,12 Thus, in some cases, percutaneous procedures represent a less invasive repair of atrial septal defect are noteworthy. 7 These data reinforce the importance of these therapies in reducing post-procedural comorbidities and length of hospitalization. 13 In developed countries, percutaneous repair of atrial septal defect is certainly the most economical option due to the lower rates of complications and shorter recovery time.…”

“…However, in developing countries, the cost of the prosthesis is still the main obstacle to the procedure. 7 An important result in the present study was the occurrence of minor complications, such as hematomas, fever, and arrhythmias, which were quickly resolved without clinical consequences for patients. The evolution of techniques and devices in paediatric interventional cardiology, such as the use of stents, balloons, and prostheses, has ensured safer procedures with fewer complications by offering other modes of cardiac structure visualization.…”

“…5 The growing number of congenital heart defects amenable to percutaneous treatment, together with the low number of complications, reduced hospitalization time, and reduced hospitalization costs, have made percutaneous interventions an excellent therapeutic option with good results in the short and long term. [5][6][7][8] This study aimed to evaluate the profile of patients with congenital heart disease undergoing percutaneous diagnostic or therapeutic procedures in a pediatric cardiology referral centre.…”

The Importance of an Accurate Cost-Effectiveness Analysis for the Introduction of New Technologies in the Brazilian Public Health System

“…4 Should this multitude of children wait even longer to have access to materials used since long in other countries and already available in Brazil for those who have access to supplementary/private health care? These are patients who we also want to treat, i.e.…”