Systematic Review and Meta-Analysis of Comparative Studies: Transcatheter Versus Surgical Closure for Postinfarct Ventricular Septal Defect

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Akira Yamaguchi, Junichi Shimamura, Shinichi Fukuhara, Hiroki Ueyama, Hisato Takagi, Toshiki Kuno
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Abstract

Background: Postinfarct ventricular septal defect (PIVSD) is a serious complication of acute myocardial infarction (AMI). Transcatheter closure is a potential alternative to surgical closure for PIVSD patients.

Objective: This meta-analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD.

Methods: A systemic search of PubMed and Embase until January 2023 identified studies comparing transcatheter versus surgical PIVSD closure. Primary outcomes included short-term mortality. Short-term mortality referred to the number of in-hospital or 30-day deaths. Secondary outcomes comprised residual shunt/reintervention incidence, difference in time from AMI or PIVSD diagnosis to intervention, the presence of cardiogenic shock, incidence of perioperative mechanical support, PIVSD size difference, and overall mortality at follow-up.

Results: Seven studies comprising 603 patients were included. Short-term mortality (OR, 1.30; 95% CI [0.90, 1.89]; p = 0.17; I2  = 3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33–9.59; p = 0.01; I2  = 63.0%) and PIVSD size (mean difference, −3.94 mm; CI [−6.90, −0.99]; p = 0.09; I2  = 83.0%) were significantly different; however, the other secondary outcomes were not significantly different.

Conclusion: Transcatheter and surgical closure demonstrate similar short-term mortality. Despite a higher incidence of residual shunt or reintervention in transcatheter closure, it may be a viable option in patients with small size of PIVSD.

Abstract Image

比较研究的系统回顾和元分析:经导管与手术闭合治疗梗死后室间隔缺损
背景:梗死后室间隔缺损(PIVSD)是急性心肌梗死(AMI)的一种严重并发症。对于 PIVSD 患者来说,经导管封堵术是手术封堵的潜在替代方案。 目的:本荟萃分析比较了经导管封堵与手术封堵治疗 PIVSD 的临床效果。 方法:在PubMed上进行系统检索:对PubMed和Embase进行系统检索,直至2023年1月,发现了比较经导管与手术PIVSD闭合的研究。主要结果包括短期死亡率。短期死亡率是指住院或30天内死亡的人数。次要结果包括残余分流/再干预发生率、从AMI或PIVSD诊断到干预的时间差、心源性休克的存在、围术期机械支持的发生率、PIVSD大小差异以及随访时的总死亡率。 结果:共纳入了七项研究,包括 603 名患者。两组患者的短期死亡率(OR,1.30;95% CI [0.90,1.89];P = 0.17;I2 = 3.0%)无显著差异。残余分流/再介入的发生率(OR,3.56;CI,1.33-9.59;P = 0.01;I2 = 63.0%)和 PIVSD 大小(平均差异,-3.94 mm;CI [-6.90,-0.99];P = 0.09;I2 = 83.0%)有显著差异;但其他次要结果无显著差异。 结论经导管封堵术和手术封堵术的短期死亡率相似。尽管经导管闭合术中残留分流或再次介入的发生率较高,但对于PIVSD较小的患者来说,经导管闭合术可能是一种可行的选择。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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