Lan Qingsu, Wu Fengchao, Ye Xudong, Wang Shaohua, Zhong Jingquan
National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Cardiology Department, Shanxi Provincial People's Hospital, Xi'an, China.
Front Cardiovasc Med. 2023 May 5;10:1082663. doi: 10.3389/fcvm.2023.1082663. eCollection 2023.
Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) is an established practice, and it requires monitoring and guidance. Both transoesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) can be used as guidance tools. However, the use of ICE and TEE in structural heart disease is controversial and the advantages and disadvantages of both for ASD and PFO closure need to be investigated. We did a systematic review and meta-analysis to compare the efficacy and safety of TEE and ICE for guiding transcatheter closure of ASD and PFO.
A systematic search of Embase, PubMed, Cochrane library, Web of Science was conducted from inception to May 2022. The outcomes of this study included average time for both fluoroscopy and the procedure, complete closure, length of stay at hospital and adverse events. This study was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI).
The meta-analysis was conducted with a total of 11 studies, involving 4,748 patients were included in meta-analysis, including 2,386 patients in the ICE group and 2,362 patients in the TEE group. The results of the meta-analysis showed that compared with TEE, ICE was shorter in time both fluoroscopy [MD: -3.72 (95%CI: -4.09 to -3.34) minutes, < 0.00001] and the procedure [MD: -6.43 (95%CI: -7.65 to -5.21) minutes, < 0.00001], shorter length of stay at hospital [MD = -0.95 (95% CI = -1.21 to -0.69) days, < 0.00001], lower incidence of adverse events (RR = 0.72, 95%CI: 0.62 to 0.84, < 0.0001), and the arrhythmia (RR = 0.50, 95% CI = 0.27 to 0.94, = 0.03) and vascular complications (RR = 0.52, 95%CI = 0.29 to 0.92, = 0.02) in ICE group were lower than those in TEE group. No significant difference in complete closure was found between ICE and TEE (RR = 1.00, 95% CI = 0.98 to 1.03, = 0.74).
Under the premise of ensuring successful rate of complete closure, ICE can shorten time between fluoroscopy and procedure and length of stay at hospital, and there was no increase in adverse events. However, more high-quality studies are needed to confirm the benefits of using ICE in ASD and PFO closure.
经导管闭合房间隔缺损（ASD）和卵圆孔未闭（PFO）是一种既定的治疗方法，需要进行监测和引导。经食管超声心动图（TEE）和心腔内超声心动图（ICE）均可作为引导工具。然而，ICE和TEE在结构性心脏病中的应用存在争议，两者在ASD和PFO闭合中的优缺点有待研究。我们进行了一项系统评价和荟萃分析，以比较TEE和ICE引导经导管闭合ASD和PFO的有效性和安全性。
从创刊至2022年5月，对Embase、PubMed、Cochrane图书馆、科学网进行了系统检索。本研究的结果包括透视和手术的平均时间、完全闭合、住院时间和不良事件。本研究采用均值差（MD）、相对风险（RR）和95%置信区间（CI）进行。
荟萃分析共纳入11项研究，涉及4748例患者，其中ICE组2386例，TEE组2362例。荟萃分析结果显示，与TEE相比，ICE的透视时间[MD：-3.72（95%CI：-4.09至-3.34）分钟，<0.00001]和手术时间[MD：-6.43（95%CI：-7.65至-5.21）分钟，<0.00001]更短，住院时间更短[MD=-0.95（95%CI=-1.21至-0.69）天，<0.00001]，不良事件发生率更低（RR=0.72，95%CI：0.62至0.84，<0.0001），ICE组的心律失常（RR=0.50，95%CI=0.27至0.94，=0.03）和血管并发症（RR=0.52，95%CI=0.29至0.92，=0.02）低于TEE组。ICE和TEE在完全闭合方面未发现显著差异（RR=1.00，95%CI=0.98至1.03，=0.74）。
在确保完全闭合成功率的前提下，ICE可缩短透视和手术时间以及住院时间，且不良事件无增加。然而，需要更多高质量的研究来证实ICE在ASD和PFO闭合中的益处。
