第二孔型房间隔缺损外科修补与经皮封堵术的比较:在低收入国家的结果和成本-效果斟酌

作     者：Vida V.L Barnoya J O’Connell M. 徐永城 

作者机构：Department of Pediatric Cardiovascular Surgery UNICAR 9 Avenue 8- 00 zona 1 Guatemala City 01011 CA GuatemalaDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第5期

页      面：46-46页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：二孔型房间隔缺损 外科修补术 封堵术 成本-效果 低收入国家 Amplatzer间隔封堵器 经皮 医疗费用 危地马拉 临床结果 

摘      要：OBJECTIVES: We compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder(ASO)(AGA Medical Corp., Golden Valley, innesota) device compared with surgical closure of an ostium secundum atrial septal defect(ASD II) in Guatemala. BACKGROUND: The percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure. METHODS: We reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures. RESULTS: Eighty-three patients with ASD II(75% ) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients(25% ) underwent surgical closure. In the device group, in 72 patients(86.7% ) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion(U.S. ＄ 3,329.50± ＄ 411.30 and U.S. ＄ 4,521.03± ＄ 429.71; p 0.001, respectively). Cost of the device(U.S. ＄ 2,930.00) proved to be the main cause for this difference. CONCLUSIONS: We confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compar ed with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective.