Pedro A Villablanca1, David A Briston2, Josep Rodés-Cabau3, David F Briceno4, Gaurav Rao5, Mohammed Aljoudi6, Aman M Shah4, Divyanshu Mohananey7, Tanush Gupta4, Mohammed Makkiya4, Harish Ramakrishna8, Mario J Garcia4, Robert H Pass9, Giles Peek10, Ali N Zaidi4. 1. Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA. Electronic address: pvillabl@montefiore.org. 2. Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA. 3. Québec Heart and Lung Institute, Quebec City, Quebec, Canada. 4. Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA. 5. Department of Cardiology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, NY, USA. 6. Department of Internal Medicine, St. Barnabas Hospital/Albert Einstein College of Medicine, New York, NY, USA. 7. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. 8. Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA. 9. Department of Pediatrics, Division of Pediatric Cardiology, Pediatric Interventional Cardiology, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, New York, NY, USA. 10. Division of Pediatric Cardiothoracic Surgery, Montefiore Health System, Albert Einstein University, New York, NY, USA; Pediatric Heart Center, Montefiore Health System, Albert Einstein University, New York, NY, USA.
Abstract
BACKGROUND: Secundum atrial septal defects (ASDs) 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 a 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% CI 0.64-0.99), total complications (RR, 0.48; 95% CI 0.35-0.65), major complications (RR, 0.57; 95% CI 0.40-0.81), minor complications (RR, 0.35; 95% CI 0.23-0.53), and LOS (DM, -2.92; 95% CI -3.25 to (-2.58)). Residual shunts were more common with TCC (RR, 3.35; 95% CI 1.72-6.51). No difference was observed regarding the need of reintervention (RR, 1.45; 95% CI 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.
BACKGROUND: Secundum atrial septal defects (ASDs) 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 a 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% CI 0.64-0.99), total complications (RR, 0.48; 95% CI 0.35-0.65), major complications (RR, 0.57; 95% CI 0.40-0.81), minor complications (RR, 0.35; 95% CI 0.23-0.53), and LOS (DM, -2.92; 95% CI -3.25 to (-2.58)). Residual shunts were more common with TCC (RR, 3.35; 95% CI 1.72-6.51). No difference was observed regarding the need of reintervention (RR, 1.45; 95% CI 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.
Authors: Reinder Evertz; Charlotte A Houck; Tim Ten Cate; Anthonie L Duijnhouwer; Rypko Beukema; Sjoerd Westra; Kevin Vernooy; Natasja M S de Groot Journal: Congenit Heart Dis Date: 2019-11-06 Impact factor: 2.007
Authors: Stine Kjaer Urhoj; Joachim Tan; Joan K Morris; Joanne Given; Gianni Astolfi; Silvia Baldacci; Ingeborg Barisic; Joanna Brigden; Clara Cavero-Carbonell; Hannah Evans; Mika Gissler; Anna Heino; Sue Jordan; Renée Lutke; Ljubica Odak; Aurora Puccini; Michele Santoro; Ieuan Scanlon; Hermien E K de Walle; Diana Wellesley; Óscar Zurriaga; Maria Loane; Ester Garne Journal: PLoS One Date: 2022-07-22 Impact factor: 3.752