Treatment Options for the Closure of Secundum Atrial Septal Defects: A Systematic Review and Meta-Analysis

• Published in: International journal of cardiology 2017-08, Vol.241, p.149-155
• Main Authors: Villablanca, Pedro A, Briston, David A, Rodés-Cabau, Josep, Briceno, David F, Rao, Gaurav, Aljoudi, Mohammed, Shah, Aman M, Mohananey, Divyanshu, Gupta, Tanush, Makkiya, Mohammed, Ramakrishna, Harish, Garcia, Mario J, Pass, Robert H, Peek, Giles, Zaidi, Ali N
• Format: Article
• Language: English
• Subjects: Atrial septal defect; Cardiac Catheterization - methods; Cardiac Catheterization - mortality; Cardiovascular; Foramen Ovale, Patent - diagnosis; Foramen Ovale, Patent - mortality; Foramen Ovale, Patent - surgery; Heart Septal Defects, Atrial - diagnosis; Heart Septal Defects, Atrial - mortality; Heart Septal Defects, Atrial - surgery; Humans; Meta-analysis; Observational Studies as Topic - methods; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - mortality; Surgery; Transcatheter; Treatment Outcome; Vascular Closure Devices
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.03.073

Abstract Background Secundum atrial septal defects (ASD) are treated by surgical closure (SC) or transcatheter device closure (TCC). Due to a scarcity of data directly comparing these approaches, it remains unclear which is superior. This meta-analysis compares the clinical outcomes of the two treatment options. Methods A literature search was performed in MEDLINE, Embase, PubMed, Google Search, and Cochrane databases for studies directly comparing SC and TCC of ASDs. Outcomes studied were major and minor acute complications, all-cause mortality, residual shunt, reinterventions, and length of stay (LOS). Relative risk (RR), difference in mean (DM) and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method with fixed effect model. In cases of heterogeneity (defined as I2 > 25%), random effect models were used. Sensitivity and meta-regression analyses were performed for each outcome. Results Of the 1742 manuscripts screened, 26 observational studies fulfilled the inclusion criteria (total n = 14,559 patients). TCC was superior to SC for the following outcomes: all-cause mortality (RR, 0.66; 95% Cl 0.64–0.99), total complications (RR, 0.48; 95% Cl 0.35–0.65), major complications (RR, 0.57; 95%Cl 0.40–0.81), minor complications (RR,0.35; 95%Cl 0.23–0.53), and LOS (DM,-2.92; 95%CI -3.25–(− 2.58)). Residual shunts were more common with TCC (RR, 3.35; 95%Cl 1.72–6.51). No difference was observed regarding the need of reintervention (RR, 1.45; 95%Cl 0.60–3.51). Meta-regression analysis showed that older age increases the risk of death and complications in patients undergoing TCC. Conclusions Though both approaches are effective, TCC is associated with lower mortality, complications, and LOS while SC has a lower rate of residual shunting.