title: Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country.
abstract: OBJECTIVE
  We compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala.
  
  
  BACKGROUND
  The percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure.
  
  
  METHODS
  We reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures.
  
  
  RESULTS
  Eighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. 3,329.50 dollars +/- 411.30 dollars and U.S. 4,521.03 dollars +/- 429.71 dollars; p < 0.001, respectively). Cost of the device (U.S. 2,930.00 dollars) proved to be the main cause for this difference.
  
  
  CONCLUSIONS
  We confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective.
authors.affiliation: Department of Pediatric Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Cardiovascular (UNICAR), Guatemala City, Guatemala. vladimirovida@interfree.it
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.forename: Joaquin
authors.initials: J
authors.lastname: Barnoya
authors.forename: Mauricio
authors.initials: M
authors.lastname: O'Connell
authors.forename: Juan
authors.initials: J
authors.lastname: Leon-Wyss
authors.forename: Luis A
authors.initials: LA
authors.lastname: Larrazabal
authors.forename: Aldo R
authors.initials: AR
authors.lastname: Castañeda
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000191:economics*; D002315:Cardiopulmonary Bypass; D002648:Child; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006166:Guatemala; D006344:Heart Septal Defects, Atrial / Q000191:economics / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019736:Prostheses and Implants / Q000191:economics*; D012189:Retrospective Studies