Transcatheter device versus surgical closure of ventricular septal defects: A clinical decision analysis

✍ Scribed by Ilyas S. Aleem; Tara Karamlou; Lee N. Benson; Brian W. McCrindle

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 183 KB
• Volume: 67
• Category: Article
• ISSN: 1522-1946
• DOI: 10.1002/ccd.20702

✦ Synopsis

Abstract

Objectives: To compare transcatheter device versus surgical closure of ventricular septal defects (VSDs). Methods: A clinical decision analysis was performed using standard gamble interviews. Results: Device was initially preferred in 39 respondents (89%) and surgery in 5 (11%). The inherent difference in value between a perfect surgery and a perfect device (disutility of surgery) was equal to a mean risk of death of (1.2 ± 2.2)%. Final values from decision analysis were initially equivalent. Values adjusted for estimated mortality, however, favored device (mean: 0.979 ± 0.032) versus surgery (mean: 0.971 ± 0.032), P = 0.052. When values were further adjusted for disutilities, device was significantly preferred (0.978 ± 0.032) versus surgery (0.961 ± 0.044), P < 0.005. Surgery would be preferred if the probability of major complications decreased below 5% or minor complications below 6%. Conclusions: When outcomes and their values are considered in a systematic manner, transcatheter device closure of suitable VSDs is favored over surgical repair. © 2006 Wiley‐Liss, Inc.