Surgical closure versus transcatheter closure for ventricular septal defect post infarction, a meta-analysis

Abstract

Background: Surgical correction of post-infarct ventricular septal defect (PIVSD) is associated with a significant incidence of morbidity and mortality. We aimed to evaluate the effectiveness and safety of surgical versus transcatheter approaches in the management of PIVSD. Methods: A systematic review and meta-analysis of retrospective from five databases including the Cochrane Library, PubMed, Web of Science, Ovid, and Scopus) until 9 March 2024 was conducted. Risk ratio (RR) for dichotomous outcomes was used and data with a 95% confidence interval (CI) are presented. Results: A total of 7 retrospective observational studies with 603 patients were included in the analysis. surgical closure was associated with a significantly lower short-term mortality and lower number of residual shunt or reintervention rate compared to percutaneous closure, with a relative risk (RR) of 1.21 (95% confidence interval (CI):1:00 to 1.46, P = 0.05) and 2.68 (95% confidence interval: 1.46 to 4.91, P = 0.001) respectively. surgical closure was associated with a non-significantly lower long-term mortality rate compared to percutaneous closure, with a relative risk (RR) of 1.10 (95% confidence interval: 0.82 to1.48, P = 0.52). No difference is reported when time from AMI or PIVSD to intervention is compared groups, with a relative risk (RR) of -0.24 (95% confidence interval: -4.49 to 4.2, P = 0.91). Conclusion: Our meta-analysis shied the light on the significance of surgical closure in terms of short-term mortality and need for re-intervention. However, no significant difference was observed in term of long-term mortality and time to intervention.