Τίτλος:
Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Mylonas, K.S.
Ziogas, I.A.
Evangeliou, A.
Hemmati, P.
Schizas, D.
Sfyridis, P.G.
Economopoulos, K.P.
Bakoyiannis, C.
Kapelouzou, A.
Tzifa, A.
Avgerinos, D.V.
Περιοδικό:
Pediatric Cardiology
Λέξεις-κλειδιά:
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
DOI:
10.1007/s00246-020-02341-y
