Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects.
BACKGROUND
Transcatheter implantation of the Amplatzer septal occluder (ASO) is an alternative to conventional surgical closure of isolated secundum atrial septal defects (ASDs). Neither the clinical outcomes nor the costs of these procedures have been extensively compared.


METHODS
We performed a retrospective cohort study to evaluate cost-effectiveness in patients with secundum ASDs who underwent closure using either placement of an ASO or surgery. We utilized available TSI accounting data to estimate hospital costs.


RESULTS
On the basis of trans-thoracic echocardiography, the procedures resulted in successful closure of the ASDs in 95.8% of patients in whom the ASO was implanted and 96.8% of surgical patients. Although there were no deaths in either group, complications occurred in 10.4% of patients in whom the ASO was implanted and 31.2% of surgical patients. The mean estimated cost per case treated with the ASO was $11,541 as compared with $21,780 for surgery. The average length of hospital stay per case treated with the ASO was 1.0 day as compared with 4.3 days for surgery. Sensitivity analyses based on our data identified no plausible situations in which the costs of surgery and of implantation of the ASO would be equal.


CONCLUSIONS
The equally effective and less costly Amplatzer Septal Occluder appears superior to surgical closure of isolated secundum ASDs in qualifying patients. The transcatheter method is also associated with significantly lower morbidity. Consequently, our results support the use of the ASO as an alternative to surgery for the management of this common congenital lesion.
Kim
Jeffrey J
JJ
Section of Pediatric Cardiology, Department of Pediatrics, University of Chicago Children's Hospital and Pritzker School of Medicine, Chicago, IL 60637, USA.
Hijazi
Ziyad M
ZM
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome