Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children

Abstract

Introduction: With advances in interventional catheterisation, transcatheter device closure of atrial septal defect (ASD) is now a feasible option to open heart surgery, especially in patients with isolated ASD. We aim to compare the outcomes, benefits and costs between device closure versus standard open-heart surgery for ASD in Singapore. Materials and Methods: This is a comparative study between 2 cohorts with isolated secundum ASDs who underwent closure of ASD either by surgery or device, at the Department of Paediatrics, National University Hospital (NUH). The clinical outcomes, complications, length of stay and total costs incurred were compared. Results: Surgical patients were at slightly greater risk of developing complications (RR=1.33; 95% CI, 0.30 to 5.95) than the device group. The median length of inpatient stay for the surgical group was significantly longer than that for the device group. Seventy percent of the patients in the device group did not need to be in ICU while 40% of patients in the surgery group stayed 2 or at least 3 days in ICU (P <0.001). The mean cost per successful procedure was $1511 (95% CI, -352 to 3375) higher for the device group patients despite a shorter length of stay in hospital. Conclusions: We concluded that transcatheter device closure is an effective and safe alternative to surgery in the treatment of suitable ASDs. Despite the high cost of the device, direct and indirect benefits for the patients and their families, who undergo device occlusion include less morbidity, better cosmesis, shorter length of stay in hospital, faster recovery and shorter time taken to resume normal activities. Key words: Amplatzer, ASD, Cost, Device occlusion, Interventional cardiology

The Prevalence of and Predisposing Factors for Late Atrial Arrhythmias after Transcatheter Closure of Secundum Atrial Septal Defects in Children

“…Transcatheter closure of secundum ASDs is almost ubiquitously available; compared to surgery, it has the same immediate efficacy and safety but lower morbidity [18,19]. Even in infants below 1 year of age, percutaneous closure is feasible [29][30][31].…”

“…It has been shown that transcatheter closure results in the normalization of cardiac size and function [9][10][11], and short-and intermediate-term studies have shown the ASO to be safe and effective [12][13][14][15]. Furthermore, it has been demonstrated that the transcatheter mortality and morbidity in this procedure are lower than the surgical approach [2,[16][17][18][19]. Nevertheless, due to the widespread use of this device, a great variety of adverse events have been reported, e.g., device embolization, erosion and cardiac perforations, thromboembolic complications, device infection, residual defects, and others, as discussed in the literature [20].…”

The effects of music intervention on anxiety and stress responses in adults with CHD undergoing cardiac catheterisation

“…1 This procedure is an attractive alternative to open-heart surgery because of its shorter hospital stay, faster return to daily life, better cosmetic outcomes, and fewer complications. 2 Percutaneous device closure is a form of interventional cardiac catheterisation that is the first-line treatment for most atrial septal defects because of its well-documented efficacy and minimal morbidity. 3 Percutaneous closure of an atrial septal defect is performed via the femoral vein under local anaesthesia in an alert state in adults.…”