Song Yi, Xing Hang, Koch Peter David, Li Xiaofei, Zhang Yan
Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Front Cardiovasc Med. 2023 Jan 6;9:1080257. doi: 10.3389/fcvm.2022.1080257. eCollection 2022.
Atrial Septal Defect/Patent Foramen Ovale (ASD/PFO) occlusion is performed to prevent paradoxical embolism and reduce the risk of recurrent ischemic stroke. Left atrial appendage (LAA) closure is used as an alternative to medical therapy of non-valvular atrial fibrillation for prevention of stroke. Multiple studies have examined performing LAA and ASD/PFO occlusion. However, the feasibility and safety of combined occlusion of the left atrial appendage and ASD/PFO are not clear, furthermore, these studies are limited by their small sample sizes and retrospective analysis. In this study, we aimed to systematically review and meta-analyze the feasibility and safety of combining left atrial appendage and ASD/PFO closure.
PubMed, Web of Science, CNKI, Cochrane Library, Embase, and WanFang database were searched up to April 2022 to identify peer-reviewed human studies on assessing the feasibility, safety, and efficacy of combining left atrial appendage and ASD/PFO closure. The primary outcome was calculated: procedural feasibility outcome and procedural safety outcome.
A total of 10 articles, including 340 patients from multiple countries, were included in the analysis. The principal findings of our study are: compared with single LAA closure, (i) combining PFO/ASD occlusion and LAA closure had similar procedural success proportion (98.43%, 95% CI: 96.67-100.00%), (ii) similar safety event incidences developed (1.67%, 95% CI: 0.24-3.92%), subgroup analyzed safety event incidences in death was 0.00 (95% CI: 0.00-0.33%), cardiac tamponade was 0.87% (95% CI: 0.00-2.77%), device embolization was 0.00 (95% CI: 0.00-0.60%), major bleeding was 0.00 (95% CI: 0.00-0.33%), stroke was 0.00 (95% CI: 0.00-0.02%).
Although this systematic review and meta-analysis demonstrate the technical feasibility and safety of combining closure of PFO/ASD and LAA, further studies of sufficient sample size, long-term follow-up, and rigor endpoint criteria are yet needed to fully evaluate this combination procedure for its role in clinical outcomes.
进行房间隔缺损/卵圆孔未闭（ASD/PFO）封堵术是为了预防反常栓塞并降低复发性缺血性中风的风险。左心耳（LAA）封堵术被用作非瓣膜性心房颤动药物治疗的替代方法以预防中风。多项研究对LAA和ASD/PFO封堵术进行了探讨。然而，左心耳和ASD/PFO联合封堵的可行性和安全性尚不清楚，此外，这些研究受样本量小和回顾性分析的限制。在本研究中，我们旨在系统评价并荟萃分析左心耳与ASD/PFO联合封堵的可行性和安全性。
检索截至2022年4月的PubMed、Web of Science、中国知网、Cochrane图书馆、Embase和万方数据库，以确定关于评估左心耳与ASD/PFO联合封堵的可行性、安全性和有效性的同行评议的人体研究。计算主要结局：手术可行性结局和手术安全性结局。
共纳入10篇文章，包括来自多个国家的340例患者。我们研究的主要发现是：与单纯LAA封堵相比，（i）PFO/ASD封堵与LAA封堵联合应用的手术成功率相似（98.43%，95%CI：96.67 - 100.00%），（ii）发生的安全事件发生率相似（1.67%，95%CI：0.24 - 3.92%），亚组分析死亡的安全事件发生率为0.00（95%CI：0.00 - 0.33%），心包填塞为0.87%（95%CI：0.00 - 2.77%），器械栓塞为0.00（95%CI：0.00 - 0.60%），大出血为0.00（95%CI：0.00 - 0.33%），中风为0.00（95%CI：0.00 - 0.02%）。
尽管本系统评价和荟萃分析证明了PFO/ASD与LAA联合封堵的技术可行性和安全性，但仍需要进一步开展样本量充足、长期随访且终点标准严格的研究，以全面评估这种联合手术在临床结局中的作用。
