Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-19T07:27:18.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Secundum atrial septal defects transcatheter closure versus surgery in adulthood: a 2000–2020 systematic review and meta-analysis of intrahospital outcomes

Part of: Surgery Atrial Septal Defect (ASD) Interventional Cardiology

Published online by Cambridge University Press:  08 April 2021

Gianluca Rigatelli Open the ORCID record for Gianluca Rigatelli [Opens in a new window] ,
Marco Zuin Open the ORCID record for Marco Zuin [Opens in a new window] ,
Loris Roncon  and
Aravinda Nanjiundappa
Gianluca Rigatelli*
Affiliation:
Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
Marco Zuin
Affiliation:
Department of Translational Medicine, University of Ferrara, Ferrara, Italy
Loris Roncon
Affiliation:
Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
Aravinda Nanjiundappa
Affiliation:
Center of Vascular Excellence, West Virginia University Medical School, Charlstone, WV, USA
*
Author for correspondence: Gianluca Rigatelli, MD, FACC, FESC, FSCAI, Section of Congenital and Structural Heart Disease Interventions, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Viale Tre Martiri, 45100, Rovigo, Italy. Tel: +3903471912016; Fax: +390425394513. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Technologically, advances in both transcatheter and surgical techniques have been continuing in the past 20 years, but an updated comprehensive comparison in device-based versus surgery in adults in terms of incidence of in-hospital mortality, perioperative stroke, and atrial fibrillation onset is still lacking. We investigate the performance of transcatheter device-based closure compared to surgical techniques by a systematic review and meta-analysis of the last 20 years literature data.

Material and methods:

The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature search was performed based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between January 2000 and October 2020, regarding the comparison between short-term outcome and post-procedural complications of atrial septal defect patients receiving transcatheter or surgical closure. The primary outcome was the comparison of in-hospital mortality from all causes between patients treated with transcatheter closure or cardiac. Secondary outcomes were the onset of post-procedural atrial fibrillation or perioperative stroke.

Results:

A total of 2360 patients were included of which 1393 [mean age 47.6 years, 952 females (68.3%)] and 967 [mean age 40.3 years, 693 females (71.6%)] received a transcatheter device-based and surgery closure, respectively. In-hospital mortality [OR 0.16 (95% CI (0.66−0.44)), p = 0.0003, I2 = 0%], perioperative stroke [OR 0.51 (95% CI (0.31−0.84)), p = 0.003, I2 = 79%], and post-procedural atrial fibrillation [OR 0.14 (95% CI (0.03−0.61)), p = 0.009, I2 = 0%] significantly favoured transcatheter device-based closure

Conclusion:

Transcatheter atrial septal defect closure resulted safer in terms of in-hospital mortality, perioperative stroke, and post-procedural atrial fibrillation compared to traditional surgery.

Keywords

CHDatrial septal defectsurgerycatheter-based closure
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 4 , April 2021 , pp. 541 - 546
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gurvitz, M, Dunn, JE, Bhatt, A, et al. Characteristics of adults with congenital heart defects in the United States. J Am Coll Cardiol 2020; 76: 175–182.CrossRefGoogle ScholarPubMed
Webb, G, Gatzoulis, MA. Atrial septal defects in the adult: recent progress and overview. Circulation 2006; 114: 1645–1653.CrossRefGoogle ScholarPubMed
Rigatelli, G, Zuin, M, Nghia, NT. Interatrial shunts: technical approaches to percutaneous closure. Expert Rev Med Devices 2018; 15: 707–716.CrossRefGoogle ScholarPubMed
O’Byrne, ML, Levi, DS. State-of-the-art atrial septal defect closure devices for congenital heart. Interv Cardiol Clin 2019; 8: 11–21.Google ScholarPubMed
Moher, D, Liberati, A, Tetzlaf, J, Altman, DG, PRISMA Group. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. J Clin Epidemiol 2009; 62: 1006–1012.CrossRefGoogle Scholar
Wells, GA, Shea, B, O’Connell, D, Peterson, J, Welch, V, Losos, M, Tugwell, P. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses, 2012, from https://www.ohrica/programs/clinical_epidemiology/oxfordasp Google Scholar
Kim, JJ, Hijazi, ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit 2002; 8: CR787–CR791.CrossRefGoogle Scholar
Mylotte, D, Quenneville, SP, Kotowycz, MA, et al. Long-term cost-effectiveness of transcatheter versus surgical closure of secundum atrial septal defect in adults. Int J Cardiol 2014; 172: 109–114.CrossRefGoogle ScholarPubMed
Chen, TH, Hsiao, YC, Cheng, CC, et al. In-hospital and 4-year clinical outcomes following transcatheter versus surgical closure for secundum atrial septal defect in adults: a national cohort propensity score analysis. Medicine (Baltimore) 2015; 94: e1524.CrossRefGoogle ScholarPubMed
Kodaira, M, Kawamura, A, Okamoto, K, et al. Comparison of clinical outcomes after transcatheter vs. minimally invasive cardiac surgery closure for atrial septal defect. Circ J 2017; 81: 543–551.CrossRefGoogle ScholarPubMed
Fujii, Y, Akagi, T, Nakagawa, K, et al. Clinical impact of transcatheter atrial septal defect closure on new onset atrial fibrillation in adult patients: Comparison with surgical closure. J Cardiol 2020; 76: 94–99.CrossRefGoogle ScholarPubMed
Kutty, S, Hazeem, AA, Brown, K, et al. Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect. Am J Cardiol 2012; 109: 1348–1352.CrossRefGoogle ScholarPubMed
Kotowycz, MA, Therrien, J, Ionescu-Ittu, R, et al. Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults. JACC Cardiovasc Interv 2013; 6: 497–503.CrossRefGoogle ScholarPubMed
Butera, G, Biondi-Zoccai, G, Sangiorgi, G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: a systematic review and meta-analysis of currently available clinical evidence. EuroIntervention 2011; 7: 377–385.CrossRefGoogle ScholarPubMed
Vida, VL, Barnoya, J, O’Connell, M, Leon-Wyss, J, Larrazabal, LA, Castaneda, AR. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol 2006; 47: 326–331.CrossRefGoogle Scholar
Salehian, O, Horlick, E, Schwerzmann, M, et al. Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J Am Coll Cardiol 2005; 45: 499–504.CrossRefGoogle ScholarPubMed
Rigatelli, G, Dell’avvocata, F, Cardaioli, P, et al. Safety and long-term outcome of modified intracardiac echocardiography-assisted “no-balloon” sizing technique for transcatheter closure of ostium secundum atrial septal defect. J Interv Cardiol 2012; 25: 628–634.CrossRefGoogle ScholarPubMed
Rigatelli, G, Zuin, M, Dell’Avvocata, F, Roncon, L, Vassilev, D, Nghia, N. Light anti-thrombotic regimen for prevention of device thrombosis and/or thrombotic complications after interatrial shunts device-based closure. Eur J Intern Med 2020; 74: 42–48.CrossRefGoogle ScholarPubMed
Rigatelli, G, Nghia, NT, Zuin, M, Conte, L, D’Elia, K, Nanjundappa, A. Very long-term outcomes of transcatheter secundum atrial septal defect closure using intracardiac echocardiography without balloon sizing. Clin Radiol 2019; 74:732.e17–732.e22.CrossRefGoogle Scholar
Schneeberger, Y, Schaefer, A, Conradi, L, et al. Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care. Interact Cardiovasc Thorac Surg 2017; 24: 603–608.Google ScholarPubMed
Mylonas, KS, Ziogas, IA, Evangeliou, A, et al. Minimally invasive surgery vs device closure for atrial septal defects: a systematic review and meta-analysis. Pediatr Cardiol 2020; 41: 853–886.CrossRefGoogle ScholarPubMed
Vida, VL, Berggren, H, Brawn, WJ, et al. Risk of surgery for congenital heart disease in the adult: a multicentered European study. Ann Thorac Surg 2007; 83: 161–168.CrossRefGoogle ScholarPubMed
Amin, Z, Hjiai, ZM, Bass, JL, Cheatham, JP, Hellebrand, WE, Klein, CS. Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimize future risk. Catheter Cardiovasc Interv 2004; 63: 496–502.CrossRefGoogle ScholarPubMed
Rigatelli, G, Dell’Avvocata, F, Cardaioli, P, et al. Five-year follow-up of intraradiac echocardiography assisted transcatheter closure of complex ostium secundum atrial septal defect. Congenit Heart Dis 2012; 7: 103–110.CrossRefGoogle ScholarPubMed
Supplementary material: File

Rigatelli et al. supplementary material

Rigatelli et al. supplementary material

Download Rigatelli et al. supplementary material(File)
File 29.1 KB