Xunmin Cheng, Shisen Jiang, Jianbin Gong, Haidong Wang, Lijun Wang
Cardiology Department, Jinling Hospital, Medical College of Nanjing University, 305 Zhongshandong Road, Nangjing, Jiangsu province, 210002, China.
Int J Cardiol. 2007 Aug 9;120(1):28-31. doi: 10.1016/j.ijcard.2006.03.092. Epub 2006 Nov 3.
Surgery for perimembranous ventricular septal defects (VSD) is widely accepted procedure with minimal operative mortality. Recent publications have reported the feasible, safe, and effective with the new Amplatzer VSD occluder. This study was done to compare the effectiveness, cost, and complications of both the techniques.
One hundred twenty-one consecutive patients from 2 to <18 years of age underwent VSD closure: 48 patients were treated surgically and 73 patients were treated with percutaneous Amplatzer occluder. Success rate, complications, cost, hospital stay, and home convalescent times were measured.
The closure rate was similar in the 2 groups: 48/48 patients (100%) in the surgical group versus 71/73 patients in the Amplatzer group (97%). Procedure complications affecting management occurred in four patients of the Amplatzer group (5.5%) and four patients of surgical patients (8.3%) (p=NS). The complications that did not need treatment were observed 25/48 patients (52%) in the surgical group versus 14/73 patients (19%) in the Amplatzer group (p<0.01). Both hospital stay and home convalescent times were significantly shorter after Amplatzer closure (median hospital stay: Amplatzer three days and surgery eleven days; median convalescent time: Amplatzer two weeks and surgery six weeks). Median cost was similar for both groups.
The closure rate was similar in the Amplatzer VSD closure and surgical closure. There were more complications in the surgical group but the majority of these was minor and did not require any change in management. Hospital stay and home convalescent times were significantly shorter after Amplatzer closure. The cost of both techniques was similar. Nevertheless, the surgeon's ability to close any VSD, regardless of anatomy, remains an important advantage of surgery.
膜周部室间隔缺损（VSD）手术是一种被广泛接受的手术，手术死亡率极低。最近的出版物报道了新型Amplatzer VSD封堵器可行、安全且有效。本研究旨在比较两种技术的有效性、成本和并发症。
121例年龄在2至<18岁的连续患者接受了VSD封堵术：48例患者接受手术治疗，73例患者接受经皮Amplatzer封堵器治疗。测量成功率、并发症、成本、住院时间和在家康复时间。
两组的封堵率相似：手术组48/48例患者（100%），Amplatzer组71/73例患者（97%）。影响治疗的手术并发症在Amplatzer组有4例患者（5.5%），手术组有4例患者（8.3%）（p=无统计学意义）。手术组有25/48例患者（52%）观察到无需治疗的并发症，而Amplatzer组为14/73例患者（19%）（p<0.01）。Amplatzer封堵术后住院时间和在家康复时间均显著缩短（中位住院时间：Amplatzer组3天，手术组11天；中位康复时间：Amplatzer组2周，手术组6周）。两组的中位成本相似。
Amplatzer VSD封堵术和手术封堵术的封堵率相似。手术组并发症更多，但大多数为轻微并发症，无需改变治疗方案。Amplatzer封堵术后住院时间和在家康复时间显著缩短。两种技术的成本相似。然而，外科医生无论VSD解剖结构如何都能进行封堵的能力仍然是手术的一个重要优势。
