经导管装置与室间隔缺损外科修补术：临床决策分析

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

作者信息

Aleem Ilyas S, Karamlou Tara, Benson Lee N, McCrindle Brian W

机构信息

Division of Cardiology and Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.

出版信息

Catheter Cardiovasc Interv. 2006 Apr;67(4):630-6. doi: 10.1002/ccd.20702.

DOI:10.1002/ccd.20702

PMID:16548005

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.

摘要

目的

比较经导管装置与手术闭合室间隔缺损（VSD）的效果。

方法

采用标准博弈访谈进行临床决策分析。

结果

39名受访者（89%）最初倾向于使用装置，5名（11%）倾向于手术。完美手术与完美装置之间的固有价值差异（手术的负效用）相当于平均死亡风险为（1.2±2.2）%。决策分析的最终价值最初是相等的。然而，根据估计死亡率调整后的价值，装置（均值：0.979±0.032）优于手术（均值：0.971±0.032），P = 0.052。当根据负效用进一步调整价值时，装置（0.978±0.032）明显优于手术（0.961±0.044），P < 0.005。如果主要并发症的概率降至5%以下或次要并发症降至6%以下，则倾向于选择手术。