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

Part of: Surgery

Published online by Cambridge University Press:  25 November 2021

Aimee-Louise Chambault Open the ORCID record for Aimee-Louise Chambault [Opens in a new window] ,
Kathryn Olsen ,
Louise J. Brown Open the ORCID record for Louise J. Brown [Opens in a new window] ,
Sophie L. Mellor Open the ORCID record for Sophie L. Mellor [Opens in a new window] ,
Nilofer Sorathia ,
Arthur E. Thomas ,
Neel Kothari  and
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window]
Aimee-Louise Chambault
Affiliation:
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Kathryn Olsen
Affiliation:
Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Louise J. Brown
Affiliation:
Foundation Programme Doctor in Surgery, North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
Sophie L. Mellor
Affiliation:
Department of General Surgery, Sandwell & West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
Nilofer Sorathia
Affiliation:
Institute of Medical and Biomedical Education, Georges, University of London, London, UK Faculty of Medical Sciences, University College London, London, UK
Arthur E. Thomas
Affiliation:
Peninsula Medical School, Peninsula College of Medicine and Dentistry, Plymouth, UK
Neel Kothari
Affiliation:
Department of General Surgery, Sandwell & West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
Amer Harky*
Affiliation:
Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
*
Author for correspondence: A. Harky, MRCS, MSc, Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. Tel: +44-151-600-1616. E-mail: [email protected]
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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.

Keywords

Atrial septal defectoutcomestranscatheter repairsurgical repair
Type
Review
Information
Cardiology in the Young , Volume 32 , Issue 1 , January 2022 , pp. 1 - 9
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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