AIM
To provide an evidence-based evaluation of all available studies comparing surgery and the transcatheter approach in ASD closure.
METHODS
Electronic databases were systematically searched for pertinent clinical studies comparing the two methods of closure (percutaneous and surgical) published up to October 2008 and reporting on > 20 patients. The primary endpoints were the occurrence of death, of total and major early complications. Pooled estimates for odds ratios (OR) were computed(random-effect method), with statistical inconsistency appraised with I2.
RESULTS
After excluding 4297 non-pertinent citations, we finally included 13 original studies (3082
patients). All studies were non-randomized comparisons between percutaneous and surgical closure.
One death was encountered in the surgical group (0.08%; 95% C.I. 0-0.23%).
Quantitative synthesis of total complications after procedure showed a 31% (95% CI 21-41%) rate
in patients treated surgically and a 6.6% (95% CI 3.9-9.2%) rate in subjects treated percutaneously.
Comparison of percutaneous closure versus surgery showed adjusted odds ratios for total
complications of 5.4 (95% CI 2.96-9.84; p<0.0001), significantly favouring percutaneous closure.
Quantitative synthesis for major complications after procedure showed a 6.8% (95% CI 4-9.5%)
rate in patients treated surgically and a 1.9% (95% CI 0.9-2.9%) rate after percutaneous closure.
Comparison of percutaneous closure versus surgery showed adjusted odds ratios for total
complications of 3.81 (95% CI 2.7-5.36; p=0.006), thus again favouring the percutaneous
approach.
CONCLUSIONS
The largest cohort to date of patients with secundum ASD shows that treatment by a percutaneous
approach has a significantly lower rate of either total or major early post-procedural complications.