@article{3121088,
    title = "Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis",
    author = "Mylonas, K.S. and Ziogas, I.A. and Evangeliou, A. and Hemmati, P. and Schizas, D. and Sfyridis, P.G. and Economopoulos, K.P. and Bakoyiannis, C. and Kapelouzou, A. and Tzifa, A. and Avgerinos, D.V.",
    journal = "Pediatric Cardiology",
    year = "2020",
    volume = "41",
    number = "5",
    pages = "853-861",
    publisher = "Springer-Verlag",
    issn = "0172-0643, 1432-1971",
    doi = "10.1007/s00246-020-02341-y",
    keywords = "adult;  bleeding;  blood transfusion;  clinical effectiveness;  cohort analysis;  female;  heart atrium septum defect;  heart tamponade;  hematoma;  human;  intermethod comparison;  length of stay;  major clinical study;  male;  minimally invasive surgery;  new-onset atrial fibrillation;  patient safety;  postoperative complication;  reoperation;  Review;  surgical approach;  systematic review;  heart catheterization;  heart septum defect;  heart surgery;  meta analysis;  middle aged;  minimally invasive surgery;  mortality;  orthopedic fixation device;  procedures;  retrospective study;  septal occluder;  sternotomy;  treatment outcome;  young adult, Adult;  Cardiac Catheterization;  Cardiac Surgical Procedures;  Female;  Heart Septal Defects, Atrial;  Humans;  Length of Stay;  Male;  Middle Aged;  Minimally Invasive Surgical Procedures;  Retrospective Studies;  Septal Occluder Device;  Sternotomy;  Surgical Fixation Devices;  Treatment Outcome;  Young Adult",
    abstract = "Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (n = 642) or device closure (n = 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9–99.9) compared to the device closure group (97.3%; 95% CI 95.6–98.2), (OR 0.1; 95% CI 0.02–0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0–19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0–9.8), (OR 2.0; 95% CI 1.2–3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7 days) compared to device closure (1.3 ± 1.4 days), (OR 4.8; 95% CI 1.1–20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7–5.5) compared to the surgical approach (0.95%; 95% CI 0.3–2.4), (OR 0.1; 95% CI 0.06–0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair. © 2020, Springer Science+Business Media, LLC, part of Springer Nature."
}