title: Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects.
abstract: Transfemoral device occlusion and minimally invasive surgical repair are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. Inpatients with isolated dcVSD who had undergone transfemoral device occlusion or minimally invasive surgical repair from January 2011 to June 2014 were reviewed for a comparative investigation between the two procedures. Procedure success was achieved in 36 transfemoral (75 %) and in 36 surgical (100 %) procedures (p = 0.001). Transfemoral patients were older, with a VSD size similar to that of surgical patients (14.5 ± 11.7 vs 4.4 ± 2.9 years, p < 0.001; 4.5 ± 1.5 vs 4.4 ± 1.3 mm, p = 0.577, respectively). No significant difference was observed in complication rates between the two treatment groups (p = 1). No large residual shunt was observed. Small residual shunt was noted in two transfemoral patients and four surgical patients (p = 0.674). All these small residual shunts closed spontaneously during follow-up. The surgical repair costs 26 % less than the device occlusion (Yuan 22063.2 ± 343.9 vs Yuan 29970.1 ± 1335.2, p < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with device occlusion, minimally invasive surgical repair can provide superior efficacy and comparable complication rates. In addition, it is 26 % cheaper than device occlusion. In low-income countries where healthcare 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, 29 Xin-Quan Road, Fuzhou, 350001, China.
authors.forename: Zhao Yang
authors.initials: ZY
authors.lastname: Chen
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
authors.forename: Yuan Ji
authors.initials: YJ
authors.lastname: Ma
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
authors.forename: Wen Zhi
authors.initials: WZ
authors.lastname: Pan
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, China.
authors.forename: Wan Hua
authors.initials: WH
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Xiong
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Fan
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, China. lianglonchenXH@126.com.
authors.forename: Liang-Long
authors.initials: LL
authors.lastname: Chen
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
authors.forename: Jun Bo
authors.initials: JB
authors.lastname: Ge
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000191:economics* / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac intervention; Catheterization; Surgery; Ventricular septal defects