Efficacy of transthoracic device closure <i>versus</i> traditional surgical repair on atrial septal defects: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LAI Wenhao ,  XIE Shaobo , KUANG Suhua , LU Guoliang , HUANG Jiezhou , MA Lunchao

Department of Cardiac Surgery, The First Affiliate Hospital of Guangzhou Medical University, Guangzhou, 510120, P.R.China;

Corresponding?author：

XIE Shaobo, Email: Cadioxsb@163.com

Keywords：

Atrial septal defect; transthoracic device closure; traditional surgical repair; postoperative complications; meta-analysis

DOI：

10.7507/1007-4848.201811003

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.Methods A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.Results Thirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).Conclusion Compared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.

Citation： LAI Wenhao, XIE Shaobo, KUANG Suhua, LU Guoliang, HUANG Jiezhou, MA Lunchao. Efficacy of transthoracic device closure versus traditional surgical repair on atrial septal defects: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(8): 795-804. doi: 10.7507/1007-4848.201811003 Copy

1.	Akagi T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol, 2015, 65(1): 17-25.
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.	俞世強, 蔡振杰, 康云帆. 胸部小切口非體外循環治療先天性心臟病房間隔缺損. 中國微創外科雜志, 2002, 2(5): 292-294.
4.	熊衛平, 羅軍, 李正國. 經胸微創封堵術與體外循環直視修補術治療房間隔缺損臨床對比分析. 醫藥前沿, 2017, 7(21): 242-244.
5.	任明明, 韓振, 閔生輝, 等. 超聲引導下外科微創封堵治療巨大房間隔缺損的臨床研究. 中國醫學創新, 2015, 12(31): 42-45.
6.	李雪濤. 微創非體外循環房間隔缺損封堵術的療效分析. 中西醫結合心血管病電子雜志, 2015, 3(10): 144-145.
7.	馬駿, 羅鑫, 張華煒, 等. 經胸小切口微創封堵術與經典外科手術治療房間隔缺損的臨床對比研究. 中國基層醫藥, 2016, 23(13): 1995-1997.
8.	劉筠, 張總剛, 唐和年, 等. 經胸非體外循環 Dasdo 技術與心臟直視手術治療房間隔缺損的對比研究. 中國心血管病研究, 2007, 5(11): 804-806.
9.	喬俊杰. 經胸微創封堵術與傳統外科手術治療大型繼發孔房間隔缺損的對比研究. 鄭州大學, 2015.53.
10.	曾文, 孟旭, 張純, 等. 繼發孔房間隔缺損 3 種治療技術的對比研究. 心肺血管病雜志, 2009, 28(1): 14-17.
11.	李才, 田作春, 朱勇德, 等. 127 例經胸微創房間隔缺損封堵術的臨床應用研究. 重慶醫學, 2015, 44(30): 4267-4269.
12.	唱寬, 谷天祥, 李峰. 繼發孔型房間隔缺損三種術式比較分析. 寧夏醫學雜志, 2014, 36(4): 323-325.
13.	尹倪, 趙天力, 楊一峰, 等. 兒童繼發孔房間隔缺損經右心房微創封堵術的臨床評估. 中南大學學報 (醫學版), 2011, 36(6): 576-580.
14.	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, 2015.34.
15.	Zhu P, Sun Y, Yang Q, et al. Intraoperative device closure of atrial septal defects with minimal transthoracic invasion: a single-center experience. Tex Heart Inst J, 2013, 40(3): 256-260.
16.	Chen Q, Cao H, Zhang GC, et al. Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. Eur J Cardiothorac Surg, 2012, 41(1): 121-125.
17.	王芯朋. 三種房間隔缺損修復術式的臨床研究. 南昌大學, 2018.32.
18.	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, 2010.40.
19.	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, (7): 1131-1133.
20.	賈明選, 劉書文, 郭亮, 等. 微創經胸房缺傘堵術治療大直徑房間隔缺損 45 例臨床分析. 西南國防醫藥, 2015, 25(11): 1187-1189.
21.	彭旭光, 錢孟佼, 許金明, 等. 實時三維心臟超聲引導下右胸切口與傳統開胸體外循環下房間隔缺損手術效果的比較. 中國胸心血管外科臨床雜志, 2013, 20(6): 637-641.
22.	肖宗位, 劉早陽, 李海林, 等. 經胸微創封堵術與傳統外科手術治療繼發孔房間隔缺損對比研究. 中國現代醫學雜志, 2009, 19(12): 1892-1894.
23.	劉于威. 微創經胸壁非體外循環房間隔缺損封堵術的臨床應用. 中國老年學雜志, 2014, 34(1): 204-205.
24.	劉建國. 用經胸微創封堵術治療小兒房間隔缺損的效果探析. 當代醫藥論叢, 2016, 14(22): 62-64.
25.	李巔遠, 閆軍, 李守軍, 等. 三種不同微創技術與經典外科技術治療房間隔缺損的臨床對比研究. 中國胸心血管外科臨床雜志, 2009, 16(1): 31-35.
26.	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.
27.	Guo Z, Zhang C, Wang H, et al. Peratrial device closure of atrial septal defect under transesophageal echocardiographic guidance without fluoroscopy compared to conventional on-pump surgical closure. Braz J Cardiovasc Surg, 2017, 32(1): 38-42.
28.	張偉, 翟光地, 張芝艷, 等. 嬰幼兒先天性房間隔缺損經胸微創封堵術與經皮股靜脈微創封堵術及傳統開胸手術的對比研究. 中國血液流變學雜志, 2017, 27(2): 200-203.
29.	李奎, 張郁林, 辜志英, 等. 食管超聲引導下經胸房間隔缺損封堵術的應用研究. 東南大學學報 (醫學版), 2015, 34(4): 521-524.
30.	遲立群, 張健群, 孔晴宇, 等. 60 歲以上老年繼發孔型房間隔缺損的治療策略 (附 139 例臨床分析). 心肺血管病雜志, 2010, 29(2): 128-131.
31.	方駿, 韋洋, 陳旭東, 等. 超聲引導下胸部微創房間隔缺損封堵術 52 例臨床分析. 第三軍醫大學學報, 2018, 40(19): 1788-1791.
32.	李小軍, 呂宏安, 劉學剛, 等. Hybrid 手術在中央型房間隔缺損修補術中的應用價值. 蚌埠醫學院學報, 2012, 37(5): 535-536.
33.	康云帆. 微創經胸壁非體外循環房間隔缺損封堵術的基礎與臨床應用研究. 第四軍醫大學, 2005.119.
34.	Romanelli G., Harper RW, Mottram PM Transcatheter closure of secundum atrial septal defects: results in patients with large and extreme defects. Heart Lung Circ, 2014, 23(2): 127-131.
35.	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.

1. Akagi T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol, 2015, 65(1): 17-25.
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. 俞世強, 蔡振杰, 康云帆. 胸部小切口非體外循環治療先天性心臟病房間隔缺損. 中國微創外科雜志, 2002, 2(5): 292-294.
4. 熊衛平, 羅軍, 李正國. 經胸微創封堵術與體外循環直視修補術治療房間隔缺損臨床對比分析. 醫藥前沿, 2017, 7(21): 242-244.
5. 任明明, 韓振, 閔生輝, 等. 超聲引導下外科微創封堵治療巨大房間隔缺損的臨床研究. 中國醫學創新, 2015, 12(31): 42-45.
6. 李雪濤. 微創非體外循環房間隔缺損封堵術的療效分析. 中西醫結合心血管病電子雜志, 2015, 3(10): 144-145.
7. 馬駿, 羅鑫, 張華煒, 等. 經胸小切口微創封堵術與經典外科手術治療房間隔缺損的臨床對比研究. 中國基層醫藥, 2016, 23(13): 1995-1997.
8. 劉筠, 張總剛, 唐和年, 等. 經胸非體外循環 Dasdo 技術與心臟直視手術治療房間隔缺損的對比研究. 中國心血管病研究, 2007, 5(11): 804-806.
9. 喬俊杰. 經胸微創封堵術與傳統外科手術治療大型繼發孔房間隔缺損的對比研究. 鄭州大學, 2015.53.
10. 曾文, 孟旭, 張純, 等. 繼發孔房間隔缺損 3 種治療技術的對比研究. 心肺血管病雜志, 2009, 28(1): 14-17.
11. 李才, 田作春, 朱勇德, 等. 127 例經胸微創房間隔缺損封堵術的臨床應用研究. 重慶醫學, 2015, 44(30): 4267-4269.
12. 唱寬, 谷天祥, 李峰. 繼發孔型房間隔缺損三種術式比較分析. 寧夏醫學雜志, 2014, 36(4): 323-325.
13. 尹倪, 趙天力, 楊一峰, 等. 兒童繼發孔房間隔缺損經右心房微創封堵術的臨床評估. 中南大學學報 (醫學版), 2011, 36(6): 576-580.
14. 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, 2015.34.
15. Zhu P, Sun Y, Yang Q, et al. Intraoperative device closure of atrial septal defects with minimal transthoracic invasion: a single-center experience. Tex Heart Inst J, 2013, 40(3): 256-260.
16. Chen Q, Cao H, Zhang GC, et al. Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. Eur J Cardiothorac Surg, 2012, 41(1): 121-125.
17. 王芯朋. 三種房間隔缺損修復術式的臨床研究. 南昌大學, 2018.32.
18. 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, 2010.40.
19. 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, (7): 1131-1133.
20. 賈明選, 劉書文, 郭亮, 等. 微創經胸房缺傘堵術治療大直徑房間隔缺損 45 例臨床分析. 西南國防醫藥, 2015, 25(11): 1187-1189.
21. 彭旭光, 錢孟佼, 許金明, 等. 實時三維心臟超聲引導下右胸切口與傳統開胸體外循環下房間隔缺損手術效果的比較. 中國胸心血管外科臨床雜志, 2013, 20(6): 637-641.
22. 肖宗位, 劉早陽, 李海林, 等. 經胸微創封堵術與傳統外科手術治療繼發孔房間隔缺損對比研究. 中國現代醫學雜志, 2009, 19(12): 1892-1894.
23. 劉于威. 微創經胸壁非體外循環房間隔缺損封堵術的臨床應用. 中國老年學雜志, 2014, 34(1): 204-205.
24. 劉建國. 用經胸微創封堵術治療小兒房間隔缺損的效果探析. 當代醫藥論叢, 2016, 14(22): 62-64.
25. 李巔遠, 閆軍, 李守軍, 等. 三種不同微創技術與經典外科技術治療房間隔缺損的臨床對比研究. 中國胸心血管外科臨床雜志, 2009, 16(1): 31-35.
26. 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.
27. Guo Z, Zhang C, Wang H, et al. Peratrial device closure of atrial septal defect under transesophageal echocardiographic guidance without fluoroscopy compared to conventional on-pump surgical closure. Braz J Cardiovasc Surg, 2017, 32(1): 38-42.
28. 張偉, 翟光地, 張芝艷, 等. 嬰幼兒先天性房間隔缺損經胸微創封堵術與經皮股靜脈微創封堵術及傳統開胸手術的對比研究. 中國血液流變學雜志, 2017, 27(2): 200-203.
29. 李奎, 張郁林, 辜志英, 等. 食管超聲引導下經胸房間隔缺損封堵術的應用研究. 東南大學學報 (醫學版), 2015, 34(4): 521-524.
30. 遲立群, 張健群, 孔晴宇, 等. 60 歲以上老年繼發孔型房間隔缺損的治療策略 (附 139 例臨床分析). 心肺血管病雜志, 2010, 29(2): 128-131.
31. 方駿, 韋洋, 陳旭東, 等. 超聲引導下胸部微創房間隔缺損封堵術 52 例臨床分析. 第三軍醫大學學報, 2018, 40(19): 1788-1791.
32. 李小軍, 呂宏安, 劉學剛, 等. Hybrid 手術在中央型房間隔缺損修補術中的應用價值. 蚌埠醫學院學報, 2012, 37(5): 535-536.
33. 康云帆. 微創經胸壁非體外循環房間隔缺損封堵術的基礎與臨床應用研究. 第四軍醫大學, 2005.119.
34. Romanelli G., Harper RW, Mottram PM Transcatheter closure of secundum atrial septal defects: results in patients with large and extreme defects. Heart Lung Circ, 2014, 23(2): 127-131.
35. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of transthoracic device closure versus traditional surgical repair on atrial septal defects: A systematic review and meta-analysis

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