title: Transcatheter versus surgical closure of atrial septum defect: a debate from a developing country.
abstract: BACKGROUND
  This study compares the effectiveness and cost of trans-catheter verses surgical closure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiac defects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention. Surgical repair is advised in a proportion of secundum type defects which are unsuitable for device closure.
  
  
  METHODS
  We reviewed the clinical course of 176 patients who underwent closure of isolated secundum ASD. The patients were assigned to either the device or surgical group depending upon the treatment they received. Successful closure was assessed immediately after the procedure. The following outcomes were studied: mortality, morbidity, hospital stay, and costs.
  
  
  RESULTS
  Ninety five patients were in the surgical group and 81 patients were in the group undergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical group and 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. The procedure success rate was 100% for the surgical group and 96.3% for the device group. The complication rate was 13.7% for surgical group and 7.4% for the device group. The mean length of hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. The procedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure.
  
  
  CONCLUSIONS
  Successful closure is achieved by both methods. Trans-catheter closure results in lower rate of complication and hospital stay but the cost of the procedure tends to be higher than surgery.
authors.affiliation: Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Waleed T
authors.initials: WT
authors.lastname: Siddiqui
authors.affiliation: Department of Cardiothoracic Surgery, The Aga Khan University Hospital (AKUH), Karachi, Pakistan.
authors.forename: Tariq
authors.initials: T
authors.lastname: Usman
authors.affiliation: Department of Pediatrics, The Aga Khan University Hospital (AKUH), Karachi, Pakistan.
authors.forename: Mehnaz
authors.initials: M
authors.lastname: Atiq
authors.affiliation: Department of Cardiothoracic Surgery, The Aga Khan University Hospital (AKUH), Karachi, Pakistan.
authors.forename: Muhammad Muneer
authors.initials: MM
authors.lastname: Amanullah
keywords: ASD; Congenital; Percutaneous; Surgery