{"title":"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","authors":"Akira Yamaguchi, Junichi Shimamura, Shinichi Fukuhara, Hiroki Ueyama, Hisato Takagi, Toshiki Kuno","doi":"10.1155/2024/8159580","DOIUrl":null,"url":null,"abstract":"<div>\n <p><b>Background:</b> 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.</p>\n <p><b>Objective:</b> This meta-analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD.</p>\n <p><b>Methods:</b> 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.</p>\n <p><b>Results:</b> Seven studies comprising 603 patients were included. Short-term mortality (OR, 1.30; 95% CI [0.90, 1.89]; <i>p</i> = 0.17; <i>I</i><sup>2</sup> <i> = </i>3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33–9.59; <i>p</i> = 0.01; <i>I</i><sup>2</sup> <i> = </i>63.0%) and PIVSD size (mean difference, −3.94 mm; CI [−6.90, −0.99]; <i>p</i> = 0.09; <i>I</i><sup>2</sup> <i> = </i>83.0%) were significantly different; however, the other secondary outcomes were not significantly different.</p>\n <p><b>Conclusion:</b> 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.</p>\n </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8159580","citationCount":"0","resultStr":"{\"title\":\"Systematic Review and Meta-Analysis of Comparative Studies: Transcatheter Versus Surgical Closure for Postinfarct Ventricular Septal Defect\",\"authors\":\"Akira Yamaguchi, Junichi Shimamura, Shinichi Fukuhara, Hiroki Ueyama, Hisato Takagi, Toshiki Kuno\",\"doi\":\"10.1155/2024/8159580\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n <p><b>Background:</b> 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.</p>\\n <p><b>Objective:</b> This meta-analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD.</p>\\n <p><b>Methods:</b> 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.</p>\\n <p><b>Results:</b> Seven studies comprising 603 patients were included. Short-term mortality (OR, 1.30; 95% CI [0.90, 1.89]; <i>p</i> = 0.17; <i>I</i><sup>2</sup> <i> = </i>3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33–9.59; <i>p</i> = 0.01; <i>I</i><sup>2</sup> <i> = </i>63.0%) and PIVSD size (mean difference, −3.94 mm; CI [−6.90, −0.99]; <i>p</i> = 0.09; <i>I</i><sup>2</sup> <i> = </i>83.0%) were significantly different; however, the other secondary outcomes were not significantly different.</p>\\n <p><b>Conclusion:</b> 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.</p>\\n </div>\",\"PeriodicalId\":15367,\"journal\":{\"name\":\"Journal of Cardiac Surgery\",\"volume\":\"2024 1\",\"pages\":\"\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8159580\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiac Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1155/2024/8159580\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiac Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2024/8159580","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Systematic Review and Meta-Analysis of Comparative Studies: Transcatheter Versus Surgical Closure for Postinfarct Ventricular Septal Defect
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.
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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