Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2006
Transcatheter device versus surgical closure of ventricular septal defects: a clinical decision analysis.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Aleem Ilyas S, Karamlou Tara, Benson Lee N, McCrindle Brian W
Аннотация
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.
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.