title: Percutaneous device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect.
abstract: BACKGROUND
  Percutaneous device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect (pmVSD) are two typical methods to reduce the invasiveness of the conventional operation through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost.
  
  
  METHODS
  Inpatients with isolated pmVSD who had undergone percutaneous device occlusion or minimally invasive surgical repair from June 2009 to June 2012 were reviewed for a comparative investigation between the two procedures.
  
  
  RESULTS
  Procedure success was achieved in 80 percutaneous (93.0%) and in 113 surgical (98.3%) procedures (p=0.076). Percutaneous patients were older, with a smaller VSD size than surgical patients (16±11.7 vs 3.8±2.4 mm, p<0.001; 4.0±1.2 vs 4.3±1.3 mm, p=0.034, respectively). Major complications occurred in 1 percutaneous (1.2%) and in 4 surgical (3.5%) procedures (p=0.602), and minor complications occurred in 27 percutaneous (33.3%) and in 37 surgical (32.2%) procedures (p=0.991). The surgical repair cost 31% less than the device occlusion (¥20,565±¥3,497 vs ¥29,795±¥2,643, p<0.001), where most of the cost was attributed to the occluder in the amount of ¥19,500.
  
  
  CONCLUSIONS
  Compared with device occlusion, minimally invasive surgical repair can provide comparable efficacy and complication rates. In addition, it is 31% cheaper than device occlusion. In low-income countries where health care resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhao Yang
authors.initials: ZY
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Bing Ru
authors.initials: BR
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Wan Hua
authors.initials: WH
authors.lastname: Chen
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Xiu Fen
authors.initials: XF
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Liang-Long
authors.initials: LL
authors.lastname: Chen
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: gejunbo888@126.com.
authors.forename: Jun Bo
authors.initials: JB
authors.lastname: Ge
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000191:economics / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D055989:Septal Occluder Device / Q000191:economics; D016896:Treatment Outcome