Ilyas S Aleem1, Tara Karamlou, Lee N Benson, Brian W McCrindle. 1. Division of Cardiology and Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
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.
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.