Transcatheter closure <i>versus</i> transthoracic closure in the treatment of simple congenital heart diseases: A systematic review and meta-analysis _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yuhao ^1,4,5,6 , XIN Liangjing ² , KUANG Hongyu ^3,4,5,6 , ZHOU Yuehang ^1,4,5,6 , JIN Xin ^1,4,5,6 , LI Yonggang ^1,4,5,6 ,  WU Chun ^1,4,5,6

1. Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, P.R.China;
2. Department of Orthodontics, Stomatological hospital of Chongqing Medical University, Chongqing, 400014, P.R.China;
3. Department of Cardiology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, P.R.China;
4. Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, P.R.China;
5. China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, P.R.China;
6. Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P.R.China;

Corresponding?author：

WU Chun, Email: wuchun007@sina.com

Keywords：

Congenital heart diseases; Transcatheter closure; Transthoracic closure; Meta-analysis

DOI：

10.7507/1007-4848.201804061

Video：

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Objective A meta-analysis was performed for a comparison of outcomes between transcatheter closure and transthoracic closure for simple congenital heart diseases (CHD). Methods Electronic databases, including PubMed, EMbase, Scopus, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for CHD administrated by transcatheter closure and transthoracic closure. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. The meta-analysis was conducted with Revman 5.3. Results Twelve studies meeting the inclusion criteria were included, involving 8 studies regarding to atrial septal defect (ASD), 2 studies regarding to ventricular septal defect (VSD) and 2 studies with regard to patent ductus arteriosus (PDA). A total of 1 423 patients were included. It was observed that compared with transthoracic closure, transcatheter closure entailed a lower complication rate (OR=5.62, 95%CI 2.78 to 11.36, P<0.001). However, meta-analysis of operative success rate(OR=1.65, 95%CI 0.92 to 2.98, P=0.09), instantly (OR=0.75, 95%CI 0.40 to 1.41, P=0.37) and long-term (OR=0.72, 95%CI 0.25 to 2.05, P=0.54) persistent shunt after surgery showed no significant differences between two approaches. No publication bias was found according to the funnel plot of complication rate and operative success rate. Conclusion In the treatment of simple CHD such as ASD, VSD and PDA, compared with transthoracic closure, a lower complication rate were associated with transcatheter closure. Meanwhile, operative success rate, instantly and long-term persistent shunt after surgery were not statistically different between the two surgical approaches. However, this study was based on retrospective studies, the level of evidence remained low. More large sample size randomized controlled trials should be designed to explore the safety and effectiveness of these two approaches in the treatment of CHD.

1.	李守軍. 努力提高復雜先天性心臟病的臨床療效. 中華臨床醫師雜志 (電子版), 2012, 6(22): 7023-7024.
2.	King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA, 1976, 235(23): 2506-2509.
3.	Hongxin L, Wenbin G, Lanmin G, et al. Intraoperative device closure of atrial septal defect using a right minithoracotomy without cardiopulmonary bypass: clinical analysis in 50 cases. Chin J Surg, 2005; 43: 653-654.
4.	Zeng XJ, Chen XF, Cheng D, et al. Peratrial closure of atrial septal defects without cardiopulmonary bypass. Asian Cardiovasc Thorac Ann, 2007, 15(3): 191-193.
5.	Zhang H, Li SJ, Li YQ, et al. Open-chest device closure for the minimally invasive management of atrial septal defect in young children. Heart Surg Forum, 2007, 10(2): E125-E128.
6.	Liang T, Xiangjun Z, Xiaojing M, et al. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients. Ann Thorac Surg, 2006, 81(4): 1417-1419.
7.	Wells G A, Shea B J, O’Connell D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
8.	Guo JJ, Luo YK, Chen ZY, et al. Long-term outcomes of device closure of very large secundum atrial septal defects: a comparison of transcatheter vs intraoperative approaches. Clin Cardiol, 2012, 35(10): 626-631.
9.	Chen Q, Cao H, Chen ZY, et al. Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect: A Chinese single-institution experience. Medicine (Baltimore), 2017, 96(11): e6316.
10.	孫小軍, 盧京. 導管介入封堵與外科微創封堵治療單純繼發孔房間隔缺損的療效比較. 中國醫藥科學, 2015, (12): 122-124.
11.	艾成, 陳有東, 程遠建, 等. 經導管封堵術經胸微創封堵術及胸骨正中切口修補術治療繼發孔型房間隔缺損的臨床療效比較. 河北醫學, 2016, 22(7): 1131-1133.
12.	齊魯. 小兒房間隔缺損經導管封堵、外科微創封堵和開胸修補術的結果對比分析. 山東大學 2010.
13.	傅志輝. 經導管封堵術、經胸微創封堵術及胸骨正中切口修補術治療繼發孔型房間隔缺損的比較. 福建醫科大學, 2015.
14.	任建立, 姚建民, 程偉偉, 等. 不同微創技術在繼發孔房間隔缺損治療中的應用. 中國循證心血管醫學雜志, 2011, 3(2): 97-100.
15.	祁長敏, 高虹. 房間隔缺損三種治療方法的比較研究. 四川醫學, 2009, 30(6): 844-846.
16.	胡振奎, 吳偉敏, 王強, 等. 室間隔缺損不同手術方式的對比研究. 實用醫學雜志, 2011, 27(18): 3363-3365.
17.	陳妙月, 陳沅, 李謐, 等. 小兒室間隔缺損 3 種不同手術方式的對比分析. 重慶醫科大學學報, 2013, (8): 896-900.
18.	彭坤. 經胸微創封堵與經導管介入封堵治療 PDA 的臨床對比研究. 鄭州大學, 2016.
19.	Chen LY, Cai P, Cheng ZD, et al. Comparison of transvenous versus transthoracic catheter-based device closure of patent ductus arteriosus with amplatzer duct occluder. J Invasive Cardiol, 2013, 25(10): 502-506.
20.	Suchon E, Pieculewicz M, Tracz W, et al. Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults: comparison of early and late results. Med Sci Monit, 2009, 15(12): C612-C617.
21.	Quek SC, Hota S, Tai BC, et al. Comparison of clinical outcomes and cost between surgical and transcatheter device closure of atrial septal defects in Singapore children. Ann Acad Med Singapore, 2010, 39(8): 629-633.
22.	Wei X, Yi W, Xu X, et al. Transthoracic occlusion for secundum atrial septal defects unsuitable for transcatheter occlusion approach. J Thorac Cardiovasc Surg, 2011, 142(1): 113-119.
23.	Schmitz C, Esmailzadeh B, Herberg U, et al. Hybrid procedures can reduce the risk of congenital cardiovascular surgery. Eur J Cardiothorac Surg, 2008, 34(4): 718-725.
24.	Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol, 2006, 47(2): 326-331.
25.	Majunke N, Bialkowski J, Wilson N, et al. Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol, 2009, 103(4): 550-554.

1. 李守軍. 努力提高復雜先天性心臟病的臨床療效. 中華臨床醫師雜志 (電子版), 2012, 6(22): 7023-7024.
2. King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA, 1976, 235(23): 2506-2509.
3. Hongxin L, Wenbin G, Lanmin G, et al. Intraoperative device closure of atrial septal defect using a right minithoracotomy without cardiopulmonary bypass: clinical analysis in 50 cases. Chin J Surg, 2005; 43: 653-654.
4. Zeng XJ, Chen XF, Cheng D, et al. Peratrial closure of atrial septal defects without cardiopulmonary bypass. Asian Cardiovasc Thorac Ann, 2007, 15(3): 191-193.
5. Zhang H, Li SJ, Li YQ, et al. Open-chest device closure for the minimally invasive management of atrial septal defect in young children. Heart Surg Forum, 2007, 10(2): E125-E128.
6. Liang T, Xiangjun Z, Xiaojing M, et al. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients. Ann Thorac Surg, 2006, 81(4): 1417-1419.
7. Wells G A, Shea B J, O’Connell D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
8. Guo JJ, Luo YK, Chen ZY, et al. Long-term outcomes of device closure of very large secundum atrial septal defects: a comparison of transcatheter vs intraoperative approaches. Clin Cardiol, 2012, 35(10): 626-631.
9. Chen Q, Cao H, Chen ZY, et al. Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect: A Chinese single-institution experience. Medicine (Baltimore), 2017, 96(11): e6316.
10. 孫小軍, 盧京. 導管介入封堵與外科微創封堵治療單純繼發孔房間隔缺損的療效比較. 中國醫藥科學, 2015, (12): 122-124.
11. 艾成, 陳有東, 程遠建, 等. 經導管封堵術經胸微創封堵術及胸骨正中切口修補術治療繼發孔型房間隔缺損的臨床療效比較. 河北醫學, 2016, 22(7): 1131-1133.
12. 齊魯. 小兒房間隔缺損經導管封堵、外科微創封堵和開胸修補術的結果對比分析. 山東大學 2010.
13. 傅志輝. 經導管封堵術、經胸微創封堵術及胸骨正中切口修補術治療繼發孔型房間隔缺損的比較. 福建醫科大學, 2015.
14. 任建立, 姚建民, 程偉偉, 等. 不同微創技術在繼發孔房間隔缺損治療中的應用. 中國循證心血管醫學雜志, 2011, 3(2): 97-100.
15. 祁長敏, 高虹. 房間隔缺損三種治療方法的比較研究. 四川醫學, 2009, 30(6): 844-846.
16. 胡振奎, 吳偉敏, 王強, 等. 室間隔缺損不同手術方式的對比研究. 實用醫學雜志, 2011, 27(18): 3363-3365.
17. 陳妙月, 陳沅, 李謐, 等. 小兒室間隔缺損 3 種不同手術方式的對比分析. 重慶醫科大學學報, 2013, (8): 896-900.
18. 彭坤. 經胸微創封堵與經導管介入封堵治療 PDA 的臨床對比研究. 鄭州大學, 2016.
19. Chen LY, Cai P, Cheng ZD, et al. Comparison of transvenous versus transthoracic catheter-based device closure of patent ductus arteriosus with amplatzer duct occluder. J Invasive Cardiol, 2013, 25(10): 502-506.
20. Suchon E, Pieculewicz M, Tracz W, et al. Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults: comparison of early and late results. Med Sci Monit, 2009, 15(12): C612-C617.
21. Quek SC, Hota S, Tai BC, et al. Comparison of clinical outcomes and cost between surgical and transcatheter device closure of atrial septal defects in Singapore children. Ann Acad Med Singapore, 2010, 39(8): 629-633.
22. Wei X, Yi W, Xu X, et al. Transthoracic occlusion for secundum atrial septal defects unsuitable for transcatheter occlusion approach. J Thorac Cardiovasc Surg, 2011, 142(1): 113-119.
23. Schmitz C, Esmailzadeh B, Herberg U, et al. Hybrid procedures can reduce the risk of congenital cardiovascular surgery. Eur J Cardiothorac Surg, 2008, 34(4): 718-725.
24. Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol, 2006, 47(2): 326-331.
25. Majunke N, Bialkowski J, Wilson N, et al. Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol, 2009, 103(4): 550-554.

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