Comparison of results and complications of surgical and Amplatzer device closure of perimembranous ventricular septal defects.
BACKGROUND
Surgery for perimembranous ventricular septal defects (VSD) is widely accepted procedure with minimal operative mortality. Recent publications have reported the feasible, safe, and effective with the new Amplatzer VSD occluder. This study was done to compare the effectiveness, cost, and complications of both the techniques.


METHODS
One hundred twenty-one consecutive patients from 2 to <18 years of age underwent VSD closure: 48 patients were treated surgically and 73 patients were treated with percutaneous Amplatzer occluder. Success rate, complications, cost, hospital stay, and home convalescent times were measured.


RESULTS
The closure rate was similar in the 2 groups: 48/48 patients (100%) in the surgical group versus 71/73 patients in the Amplatzer group (97%). Procedure complications affecting management occurred in four patients of the Amplatzer group (5.5%) and four patients of surgical patients (8.3%) (p=NS). The complications that did not need treatment were observed 25/48 patients (52%) in the surgical group versus 14/73 patients (19%) in the Amplatzer group (p<0.01). Both hospital stay and home convalescent times were significantly shorter after Amplatzer closure (median hospital stay: Amplatzer three days and surgery eleven days; median convalescent time: Amplatzer two weeks and surgery six weeks). Median cost was similar for both groups.


CONCLUSIONS
The closure rate was similar in the Amplatzer VSD closure and surgical closure. There were more complications in the surgical group but the majority of these was minor and did not require any change in management. Hospital stay and home convalescent times were significantly shorter after Amplatzer closure. The cost of both techniques was similar. Nevertheless, the surgeon's ability to close any VSD, regardless of anatomy, remains an important advantage of surgery.
Xunmin
Cheng
C
Cardiology Department, Jinling Hospital, Medical College of Nanjing University, 305 Zhongshandong Road, Nangjing, Jiangsu province, 210002, China. chengxunm2002@yahoo.com.cn
Shisen
Jiang
J
Jianbin
Gong
G
Haidong
Wang
W
Lijun
Wang
W
D000293:Adolescent; D006328:Cardiac Catheterization / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000191:economics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019919:Prosthesis Implantation / Q000191:economics / Q000295:instrumentation*; D016896:Treatment Outcome