Transcatheter device versus surgical closure of ventricular septal defects: a clinical decision analysis.
OBJECTIVE
To compare transcatheter device versus surgical closure of ventricular septal defects (VSDs).


METHODS
A clinical decision analysis was performed using standard gamble interviews.


RESULTS
Device was initially preferred in 39 respondents (89%) and surgery in 5 (11%). The inherent difference in value between a perfect surgery and a perfect device (disutility of surgery) was equal to a mean risk of death of (1.2 +/- 2.2)%. Final values from decision analysis were initially equivalent. Values adjusted for estimated mortality, however, favored device (mean: 0.979 +/- 0.032) versus surgery (mean: 0.971 +/- 0.032), P = 0.052. When values were further adjusted for disutilities, device was significantly preferred (0.978 +/- 0.032) versus surgery (0.961 +/- 0.044), P < 0.005. Surgery would be preferred if the probability of major complications decreased below 5% or minor complications below 6%.


CONCLUSIONS
When outcomes and their values are considered in a systematic manner, transcatheter device closure of suitable VSDs is favored over surgical repair.
Aleem
Ilyas S
IS
Division of Cardiology and Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
Karamlou
Tara
T
Benson
Lee N
LN
McCrindle
Brian W
BW
D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D017060:Patient Satisfaction; D018570:Risk Assessment; D016896:Treatment Outcome