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
Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
Int J Cardiol. 2017 Aug 15;241:149-155. doi: 10.1016/j.ijcard.2017.03.073. Epub 2017 Mar 24.
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.
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 I>25%), random effect models were used. Sensitivity and meta-regression analyses were performed for each outcome.
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.
Though both approaches are effective, TCC is associated with lower mortality, complications, and LOS while SC has a lower rate of residual shunting.
继发孔型房间隔缺损（ASD）可通过外科闭合术（SC）或经导管装置闭合术（TCC）进行治疗。由于直接比较这两种方法的数据稀缺，哪种方法更具优势仍不明确。本荟萃分析比较了这两种治疗方案的临床结局。
在MEDLINE、Embase、PubMed、谷歌搜索和Cochrane数据库中进行文献检索，以查找直接比较ASD的SC和TCC的研究。研究的结局包括严重和轻微急性并发症、全因死亡率、残余分流、再次干预以及住院时间（LOS）。使用Mantel-Haenszel方法和固定效应模型计算相对风险（RR）、平均差异（DM）和95%置信区间（CI）。在存在异质性的情况下（定义为I>25%），使用随机效应模型。对每个结局进行敏感性和荟萃回归分析。
在筛选的1742篇手稿中，26项观察性研究符合纳入标准（共14559例患者）。TCC在以下结局方面优于SC：全因死亡率（RR，0.66；95%CI 0.64-0.99）、总并发症（RR，0.48；95%CI 0.35-0.65）、严重并发症（RR，0.57；95%CI 0.40-0.81）、轻微并发症（RR，0.35；95%CI 0.23-0.53）和LOS（DM，-2.92；95%CI -3.25至（-2.58））。TCC的残余分流更常见（RR，3.35；95%CI 1.72-6.51）。在再次干预需求方面未观察到差异（RR，1.45；95%CI 0.60-3.51）。荟萃回归分析表明，年龄较大增加了接受TCC患者的死亡和并发症风险。
虽然两种方法都有效，但TCC与较低的死亡率、并发症和LOS相关，而SC的残余分流率较低。
