Closure of Atrial Septal Defects: Is there Still a Place for Surgery ?

Bové, Thierry; François, Katrien; K, De Groote; Suys, Bert; Wolf, Daniël De; G, Van Nooten

doi:10.1080/00015458.2005.11679767

Cited by 14 publications

(7 citation statements)

References 18 publications

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“…The atrial septal defect (ASD) occlusion is traditionally performed through cardiac surgery, and the access to cardiac area is obtained through classic median sternotomy with extracorporeal circulation, which involves a post-operation period in intensive care unit, a requirement that contributes to significant increase of costs in the Brazilian health system [8] .…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

Costa¹,

Santos²,

Sarti

et al. 2014

PLoS ONE

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ObjectivesThe study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant.MethodsA model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant.ResultsThe results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio.ConclusionsThe proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.

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Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

Costa¹,

Santos²,

Sarti

et al. 2014

PLoS ONE

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show abstract

“…5,7 Accurate assessment of an ASD in terms of its morphology, defect size relative to the atrial septal length, position in the atrial septum and adequacy of margins is paramount in determining the suitability for device closure and hence maximising the procedural success rate. 8,14,15 Imaging modalities currently employed include transoesophageal echocardiography (TOE), transthoracic echocardiography (TTE), intracardiac echocardiography (ICE) and fluoroscopy; but they all have their limitations.…”

Section: Introductionmentioning

confidence: 99%

Assessing ASDs prior to device closure using 3D echocardiography. Just pretty pictures or a useful clinical tool?

Morgan¹,

Casey²,

Craig³

et al. 2007

European Journal of Echocardiography

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Aims To determine the usefulness of three-dimensional transthoracic echocardiography (3D echo) in assessment of secundum atrial septal defects (ASDs) considered for device closure. To compare the findings from 3D echo with those from two-dimensional transoesophageal echocardiography (TOE) regarding dimensions, morphology and suitability for device closure. Methods and results Twenty-four patients were enrolled in this prospective, crossover study. Threedimensional echo and TOE data were collected, analysed and compared, assessing quantitative data including maximum defect diameter, area and circumference. Qualitative morphology such as the presence of fenestrations and the defect margins were noted, and an assessment of the suitability for device closure was made using each modality. Eighteen (75%) of the 3D data sets produced usable data for analysis. In each case the maximum diameter of the defect was larger on 3D echo than on TOE (mean difference ¼ 0.34 cm, P , 0.001). On three occasions suitability for device closure could not be determined using 3D echo. On the other 15 occasions there was agreement between the TOE and 3D echo data. Conclusions Three-dimensional echo provides comparable data with TOE when attempting to predict suitability for device closure without the need for general anaesthetic or sedation. It also provides useful additional dynamic and morphological information.

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“…1 The first report on device closure of ASD was in 1976 by King et al 3 It has the advantage of saving the patient from open heart surgery and cardiopulmonary bypass and allowing a shorter hospital stay and faster rehabilitation. 4 This mode of therapy has gained wide acceptance worldwide and is routine in many countries including some centers in Africa, but before the cases presented here, it had never been performed in Nigeria. In October 2009, a private cardiac catheterization laboratory was opened in Lagos at the Reddington Multispecialty Hospital.…”

Section: Introductionmentioning

confidence: 95%

“…1 This mode of therapy appears now to be widely accepted based on the obvious advantage of saving the patient from open heart surgery and cardiopulmonary bypass and allowing subsequent faster rehabilitation. 4 Catheter-based closure is now considered the first-line treatment strategy for secundum ASDs. A percutaneous approach is suitable for the vast majority of patients with secundum ASDs, except those with insufficient rims to secure the device and those with coincidental anomalous pulmonary venous return.…”

mentioning

confidence: 99%

Transcatheter closure of secundum atrial septal defect in adults: report of our first experience in a developing country

Animasahun¹,

Aluko²,

Johnson³

et al. 2014

OAS

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Closure of Atrial Septal Defects: Is there Still a Place for Surgery ?

Cited by 14 publications

References 18 publications

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

Assessing ASDs prior to device closure using 3D echocardiography. Just pretty pictures or a useful clinical tool?

Transcatheter closure of secundum atrial septal defect in adults: report of our first experience in a developing country

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