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.
Division of Cardiology and Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
Ilyas S
IS
Aleem
Tara
T
Karamlou
Lee N
LN
Benson
Brian W
BW
McCrindle
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