Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children

Hughes, Marina; Maskell, Giles; Goh, T.H.; Wilkinson, James L.

doi:10.1136/heart.88.1.67

Cited by 73 publications

(33 citation statements)

References 15 publications

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“…345 Traditional operative strategies, such as pericardial or synthetic patch closure, have been well established, with a low complication rate and a mortality rate close to zero among patients without pulmonary hypertension. [346][347][348][349] Recently, there have been an increasing number of reports regarding results after surgical closure among elderly patients (>60 years of age) that demonstrate equivalent survival to younger patients, albeit with slightly higher complication rates. 36,350,351 In a study 36 of 68 patients between 68 and 86 years of age at a single institution undergoing either surgical (n=13) or device (n=54) closure, the incidence of major complications (including pneumothorax, heart failure, and pneumonia) was 23%, higher than that recently reported 352 using the Society of Thoracic Surgeons' Congenital Heart Surgery Database (20%) and in another recent single-institution review 353 (12%).…”

Section: Primary Lesions In Achdmentioning

confidence: 99%

Congenital Heart Disease in the Older Adult

Bhatt¹,

Foster²,

Kuehl³

et al. 2015

Circulation

203

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Section: Primary Lesions In Achdmentioning

confidence: 99%

Congenital Heart Disease in the Older Adult

Bhatt¹,

Foster²,

Kuehl³

et al. 2015

Circulation

203

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“…Other recently published studies comparing surgical vs. transcatheter closure have reported good short-term outcomes [5,10,27]. A comparison of the two methods in terms of late cardiac morbidity is as yet unavailable.…”

Section: Discussionmentioning

confidence: 99%

“…Transcatheter closure with an occluding device is an alternative method that nowadays is also used frequently in children. Considering the excellent results after surgical closures, the question arises of whether the advantages of transcatheter closure (no cardiopulmonary bypass, no thoracotomy or scar, shorter hospital stay, lower costs) justify its use in children with respect to the long-term outcome [5,7,10,27]. Because information on long-term morbidity is sparse, the aim of this study was to provide additional data on the long-term outcome in patients with surgical closure of an ASD in childhood.…”

mentioning

confidence: 99%

Long-term Outcome after Surgical Closure of Atrial Septal Defect in Childhood with Extensive Assessment Including MRI Measurement of the Ventricles

et al. 2005

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Abstract. Surgical closure of the secundum type of atrial septal defect (ASD) in childhood leads to excellent survival. However, relevant morbidity has been reported. Transcatheter closure of these defects has now become an alternative approach. To compare the results of the two different interventions, reliable data are needed on the long-term morbidity after defect closure with both methods. Patients were evaluated after a minimum of 10 years after surgical closure of an ASD in childhood. Assessment included analysis of perioperative data, interview, clinical examination, electrocardiogram, (ECG), 24-hour ECG, ergometry, chest radiograph, echocardiography, and MRI. A total of 66 patients underwent operation between 1971 and 1986 at our institution. Forty-eight of them (73%) were interviewed and 38 (58%) participated fully in the study program. Eighteen (27%) either refused to participate or were lost to follow-up. There were no substantial residual disorders, such as arrhythmias, right-sided heart dilatation, pulmonary hypertension, or reduced work capacity. Surgical closure of an ASD in childhood has an excellent long-term outcome. Surgical closure is thus the standard against which transcatheter closure needs to be measured.

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“…Na Austrália, foi realizado estudo prospectivo que comparou, além do desfecho clínico, custos hospitalares e impacto familiar dos fechamentos cirúrgico e percutâneo dos defeitos do septo atrial. 57 Quando avaliados apenas os custos diretamente relacionados ao procedimento, o cateterismo se mostrou mais oneroso que o procedimento cirúrgico. Entretanto, a necessidade de maior tempo de internação, enfermagem, exames subsidiários e medicamentos contribuiu para o aumento dos custos da atriosseptoplastia cirúrgica, ultrapassando o valor gasto para a atriosseptoplastia percutânea (12.969 dólares australianos vs. 11.845 dólares australianos).…”

Section: Custos Da Atriosseptoplastia Percutânea E Cirúrgicaunclassified

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

Filho¹,

Mânica²,

Cardoso³

2010

Rev. Bras. Cardiol. Invasiva

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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...

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Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children

Cited by 73 publications

References 15 publications

Congenital Heart Disease in the Older Adult

Congenital Heart Disease in the Older Adult

Long-term Outcome after Surgical Closure of Atrial Septal Defect in Childhood with Extensive Assessment Including MRI Measurement of the Ventricles

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

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