Comparison of efficacy and cost between transcatheter and surgical closure of secundum atrial septal defect

Objective To compare the efficacy, safety and cost between Amplatzer occluder and surgical closure of secundum atrial septal defect. Methods According to the same inclusion criteria, 273 patients with secundum atrial septal defect were treated by surgical closure (159 cases) or transcatheter closure with Amplatzer occluder (114 cases). In surgery group, there were 51 male patients, 118 female patients with median age of (20.7±15.1) years old. In transcatheter closure group, there were 46 male patients, 68 female patients with median age of (25.4±16.1) years old. The median sizes of atrial septal defect of surgery group and transcatheter closure group were (18.9±6.1) mm and (16.5±5.0) mm respectively( P =0.01). Results The procedural attempt successful rate was 100% for surgery group and 96.9% for transcatheter closure group ( P =0.007). Residual shunt rates of surgery group and transcatheter closure group were 1.2% and 2.7% respectively( P 0.05). Total complication rates of surgery group and transcatheter closure group were 15.1% and 2.7% respectively ( P 0.05), major complication rates of each group were 2.5% and 0 respectively ( P 0.05), minor complication rates of each group were 13.2% and 2.7% respectively ( P 0.05). No patient need blood transfusion in transcatheter closure group whereas 66 patients accepted blood transfusion of mean volume (577±191) ml. There was a significant negative linear correlation between age and blood transfusion volume ( r =0.573, P 0.05) in surgery group. The costs of surgery group and transcatheter closure group were (20 687.92±4807.95) RMB and (44 188.38±3 189.35) RMB, respectively( P 0.005). The mean lengths of hospital stay were (2.87±1.82) days and (12.9± 3.74) days, respectively( P 0.005). Conclusion Although the procedural ttempt successful rate of transcatheter closure group was lower than that of surgery group, the residual shunt rates of both groups were similar. In the transcatheter closure group, which no patient need blood transfusion with shorter hospital stays, the complication rate is lower than that of surgery group. However the cost of transcatheter closure group was higher than that of surgery group. There will be more patients with atrial septal defect benefited from Amplatzer occluder if its price could be reduced.