title: Comparison of results and economic analysis of surgical and transcatheter closure of perimembranous ventricular septal defect.
abstract: OBJECTIVE
  The last decade has witnessed considerable improvement in design and implantation techniques for the percutaneous closure of perimembranous ventricular septal defects. This study was undertaken to compare the results and economic analysis of traditional surgery and percutaneous closure with a modified double-disk occluder during hospitalization.
  
  
  METHODS
  A total of 345 consecutive patients who underwent isolated perimembranous ventricular septal defect closure were identified between July 2009 and July 2011 in our institution. A total of 157 patients with perimembranous ventricular septal defect (45.5%) underwent percutaneous closure and the remaining 188 patients (54.5%) were treated surgically.
  
  
  RESULTS
  In the percutaneous closure group, 156 patients (99.4%) had immediate complete closure and 186 (98.9%) in the surgical group were treated successfully (P = 0.671). The surgical group was significantly younger (P = 0.000) and larger in size (P = 0.000). One case of irreversible complete atrioventricular block and one death occurred in the surgical group. There was no significant difference in terms of hospital stay between the two groups. The total medical cost in the percutaneous closure group was lower compared with that in the surgical group (P = 0.005). Charges for medication, bed occupancy and nursing care of patients undergoing surgical closure were greater than those for patients undergoing transcatheter closure (P = 0.000, P = 0.000, P = 0.000, respectively). None of the patients in the percutaneous closure group required blood transfusion during hospitalization. Charges for radiography, lab and ultrasound in the percutaneous closure group were higher compared with those in the surgical group (P = 0.000, P = 0.000, respectively).
  
  
  CONCLUSIONS
  Compared with surgical repair at our institution, the superior clinical outcomes and economic benefits of percutaneous closure are inspiring. Percutaneous closure is a valuable alternative to surgery and allows more patients to be effectively treated in China.
authors.affiliation: Department of Cardiology,  Changhai Hospital, 2nd Military Medical University, Shanghai,  China.
authors.forename: Suxuan
authors.initials: S
authors.lastname: Liu
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Xueyan
authors.initials: X
authors.lastname: Ding
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Zhao
authors.forename: Wen
authors.initials: W
authors.lastname: Ke
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Xianxian
authors.initials: X
authors.lastname: Zhao
authors.forename: Yongwen
authors.initials: Y
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D019919:Prosthesis Implantation / Q000191:economics / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult