Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

Yang Zhou,Fei Zhao,Hua-Li Peng,Yun-Han Jiang,Shi-Hai Tang,Ling-Xi Liu

doi:10.1038/s41598-017-12500-6

Abstract

Transthoracic device closure (TTDC) is thought to be a promising technology for the repair of ventricular septal defects (VSDs). However, there is considerable controversy regarding the efficacy and safety of TTDC. The present study aimed to compare the benefits and safety of TTDC with those of conventional open-heart surgery (COHS) and analyze the associated factors causing complications, conversion to COHS and reoperation. Electronic database searches were conducted in PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese databases. A total of 5 randomized controlled trials (RCTs), 7 cohort studies, 13 case-control studies, 129 case series and 13 case reports were included. Compared to COHS, TTDC exhibited superior efficacy with a significantly lower risk of post-operative arrhythmia; however, no significant differences in other outcomes were identified. Meta-regression analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a smaller occluder, and a median or subxiphoid approach lowered the relative risk of several post-operative complications, conversion to COHS and reoperation. The current evidence indicates that TTDC is associated with a lower risk of post-operative arrhythmia and is not associated with an increased risk of complications. PmVSDs, a smaller VSD and occluder, and a median or subxiphoid approach correlate with better outcomes when using TTDC.

Highlights

Ventricular septal defects (VSDs) are one of the most common congenital heart diseases, accounting for approximately 20–40% of all cardiac malformations[1,2]
The analysis revealed that perimembranous VSDs (pmVSDs) was the only protective factor (p = 0.003), whereas doubly committed subarterial VSD (dcsVSD) (p = 0.048), the special type of ventricular septal defects (VSDs) (p = 0.022) and the size of the occluder (p = 0.001) increased the risk of conversion to conventional open-heart surgery (COHS)
Regarding intra-operative complications, we found no convincing evidence of a reduced risk of arrhythmias, aortic insufficiency or residual shunts in the transthoracic device closure (TTDC) group, due to contradictions between the results of cohort studies and case-control studies or limited evidence

Summary

Introduction

Ventricular septal defects (VSDs) are one of the most common congenital heart diseases, accounting for approximately 20–40% of all cardiac malformations[1,2]. The percutaneous approach can be problematic due to its vascular-related complications Based on these factors, transthoracic device closure (TTDC), a new hybrid technology combining percutaneous occlusion and open-heart surgery closure, has been developed. Transthoracic device closure (TTDC), a new hybrid technology combining percutaneous occlusion and open-heart surgery closure, has been developed This novel approach can be used to avoid cardiopulmonary bypass and median sternotomy, and vascular injuries caused by interventional closure. Several investigators have reported a higher morbidity of an intra-operative residual shunt in the TTDC group than that in COHS6. Another unavoidable matter is the factors that affect the conversion from TTDC to COHS.

Methods

Results

Discussion

Conclusion