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Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis.

Publication ,  Journal Article
Mylonas, KS; Ziogas, IA; Evangeliou, A; Hemmati, P; Schizas, D; Sfyridis, PG; Economopoulos, KP; Bakoyiannis, C; Kapelouzou, A; Tzifa, A ...
Published in: Pediatric cardiology
June 2020

Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (n = 642) or device closure (n = 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9-99.9) compared to the device closure group (97.3%; 95% CI 95.6-98.2), (OR 0.1; 95% CI 0.02-0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0-19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0-9.8), (OR 2.0; 95% CI 1.2-3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7 days) compared to device closure (1.3 ± 1.4 days), (OR 4.8; 95% CI 1.1-20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7-5.5) compared to the surgical approach (0.95%; 95% CI 0.3-2.4), (OR 0.1; 95% CI 0.06-0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair.

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Published In

Pediatric cardiology

DOI

EISSN

1432-1971

ISSN

0172-0643

Publication Date

June 2020

Volume

41

Issue

5

Start / End Page

853 / 861

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Surgical Fixation Devices
  • Sternotomy
  • Septal Occluder Device
  • Retrospective Studies
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Length of Stay
 

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Mylonas, K. S., Ziogas, I. A., Evangeliou, A., Hemmati, P., Schizas, D., Sfyridis, P. G., … Avgerinos, D. V. (2020). Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis. Pediatric Cardiology, 41(5), 853–861. https://doi.org/10.1007/s00246-020-02341-y
Mylonas, Konstantinos S., Ioannis A. Ziogas, Alexandros Evangeliou, Pouya Hemmati, Dimitrios Schizas, Panagiotis G. Sfyridis, Konstantinos P. Economopoulos, et al. “Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis.Pediatric Cardiology 41, no. 5 (June 2020): 853–61. https://doi.org/10.1007/s00246-020-02341-y.
Mylonas KS, Ziogas IA, Evangeliou A, Hemmati P, Schizas D, Sfyridis PG, et al. Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis. Pediatric cardiology. 2020 Jun;41(5):853–61.
Mylonas, Konstantinos S., et al. “Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis.Pediatric Cardiology, vol. 41, no. 5, June 2020, pp. 853–61. Epmc, doi:10.1007/s00246-020-02341-y.
Mylonas KS, Ziogas IA, Evangeliou A, Hemmati P, Schizas D, Sfyridis PG, Economopoulos KP, Bakoyiannis C, Kapelouzou A, Tzifa A, Avgerinos DV. Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis. Pediatric cardiology. 2020 Jun;41(5):853–861.
Journal cover image

Published In

Pediatric cardiology

DOI

EISSN

1432-1971

ISSN

0172-0643

Publication Date

June 2020

Volume

41

Issue

5

Start / End Page

853 / 861

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Surgical Fixation Devices
  • Sternotomy
  • Septal Occluder Device
  • Retrospective Studies
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Length of Stay