Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes

Abstract

Background: Atrial septal defects are a common form of CHD and dependent on the size and nature of atrial septal defects, closure may be warranted. The paper aims to compare outcomes of transcatheter versus surgical repair of atrial septal defects. Methods: A comprehensive electronic literature search was conducted. Primary studies were included if they compared both closure techniques. Primary outcomes included procedural success, mortality, and reintervention rate. Secondary outcomes included residual defect and mean hospital stay. Results: A total of 33 studies were included in meta-analysis. Mean total hospital stay was significantly shorter in the transcatheter cohort across both the adult (95% confidence interval, mean difference −4.05 (−4.78, −3.32) p < 0.00001) and paediatric populations (95% confidence interval, mean difference −4.78 (−5.97, −3.60) p < 0.00001). There were significantly fewer complications in the transcatheter group across both the adult (odds ratio 0.45, 95% confidence interval, [0.28, 0.72], p < 0.00001) and paediatric cohorts (odds ratio 0.26, 95% confidence interval, [0.14, 0.49], p < 0.00001). No significant difference in overall mortality was found between transcatheter versus surgical closure across the two groups, adult (odds ratio 0.76, 95% confidence interval, [0.40, 1.45], p = 0.41), paediatrics (odds ratio 0.62, 95% confidence interval, [0.21, 1.83], p = 0.39). Conclusion: Both transcatheter and surgical approaches are safe and effective techniques for atrial septal defect closure. Our study has demonstrated the benefits of transcatheter closure in terms of lower complication rates and mean hospital stay. However, surgery still has a place for more complex closure and, as we have demonstrated, shows no difference in mortality.

Cardiopulmonary functional capacity in Taiwanese children with atrial septal defects

“…33 In subgroup analysis, our findings suggested that lung function and CPET test results are comparable among children with surgically closed ASD, transcatheter-closed ASD, and unrepaired ASD. Both surgical and percutaneous closure methods are effective interventions for ASD with similar mortality rates, and almost 85% to 90% of all secundum ASD can be closed by using a transcatheter approach, [34][35][36] although less evidence has directly compared catheter and surgical ASD closure in terms of CPET parameter. An observational study revealed a higher decreased VE/VCO 2 slope in ASD patients after catheter closure than surgical closure at 1-year follow-up, while echocardiographic parameters did not differ significantly.…”

Unveiling an Unusual Cause of Cardiac Tamponade

“…In recent years, the use of percutaneously implanted occluding devices for the closure of OS ASD has become an increasingly popular alternative to surgical closure for patients with suitable anatomy, due to its minimally invasive nature and reduced rate of early complications and length of stay [ 2 , 3 ]. However, these devices can be associated with late complications, including residual shunt, device erosion, device migration, late device fracture, thrombus formation, infective endocarditis, and atrial arrhythmias [ 3 , 4 , 5 , 6 , 8 ].…”

“…There are four types of ASD, and while all of them can be surgically closed, only the ostium secundum (OS) defect can be percutaneously closed. Thus, in recent years, the use of percutaneously implanted occluding devices for the closure of ASD has become an increasingly popular alternative to surgical closure for patients with suitable anatomy, due to its minimally invasive nature and reduced rate of early complications and length of stay [ 2 ]. However, these devices are associated with potential complications, both early and late [ 3 , 4 , 5 , 6 ].…”

Çocuklarda, Ergenlerde ve Genç Yetişkinlerde Transtorasik Ekokardiyografi ve Floroskopi Kılavuzluğunda Cihazla Transkateter Atriyal Septal Defekt Kapatılması

“…Floroskopi ile ölçülen gerilmiş balon çapı ortanca değeri 14 mm (ÇAA 12.4-18)'di. Ortanca cihaz bel çapı 14 mm (ÇAA [13][14][15][16][17][18], ortanca cihaz sol atriyal (SlA) disk çapı 28 mm (ÇAA [26][27][28][29][30][31] ve SlA disk çapının toplam septal çapa oranı ortanca değeri %75 (ÇAA 68-81)'di. Ortanca floroskopi ve işlem süreleri sırasıyla 8 dakika (ÇAA 5.6-13.75) ve 36.5 dakika (ÇAA 30-49)'du.…”