Comparison of surgical vs. non-surgical closure procedures for secundum atrial septal defect

Background Surgery has been the standard therapy for secundum atrial septal defect (ASD) closure, but it has significant associated morbidities related to sternotomy, cardiopulmonary bypass, complications, residual scars, and trauma. A less invasive non-surgical approach with transcatheter devices was developed to occlude ASD. Amplatzer septal occluder (ASO) is a common device in transcatheter closure.Objective To compare two secundum ASD closure procedures, transcatheter closure by ASO and surgical closure, in terms of efficacy, complications, length of hospital stay, and total costs.Methods A retrospective analysis was performed on children with secundum ASD admitted to the Cardiology Center of Cipto Mangunkusumo Hospital from January 2005 to December 2011. Patients received either transcatheter closure with ASO or surgical closure procedures. Data was obtained from patients’ medical records.Results A total of 112 secundum ASD cases were included in this study, consisting of 42 subjects who underwent transcatheter closure procedure by ASO and 70 subjects who underwent surgical closure procedure. Procedure efficacies of surgery and ASOo were not significantly different (98.6% vs 95.2%, respectively, P=0.555). However, subjects who underwent surgical procedures had significantly more complications than subjects who underwent transcatheter closure procedure (60% vs 28.6%, respectively, OR 1.61; 95%CI 1.19 to 2.18; P=0.001). Hospital stays were also significantly longer for surgical patients than for transcatheter closure patients (6 days vs 2 days, respectively, P<0.0001). In addition, all surgical subjects required intensive care. Transcatheter closure had a mean total cost of 52.7 (SD 6.7) million Rrupiahs while the mean cost of surgery was 47 (SD 9.2) million Rupiahs (P<0.0001). Since the ASO device cost represented 58% of the total cost of transcatheter closure, the mean cost of transcatheter closure procedure without the device itself was less costly than surgery.Conclusion Transcatheter closure using ASO has a similar efficacy to that of surgical closure procedure. However, subjects who underwent transcatheter closure have lower complication rates and shorter length of hospital stays than subjects who had surgery, but transcatheter closure costs are higher compared to the surgical procedure. [Paediatr Indones.