Efficacy of transthoracic device closure versus surgical closure on ventricular septal defects: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Yang ¹ , LIU Lingxi ¹ , ZHAO Fei ¹ , TANG Shihai ¹ ,  PENG Huali ¹ ,  XIAO Yingbin ²

1. Department of Cardiothoracic Surgery, the People’s Hospital of Leshan, Leshan, 614000, Sichuan, P.R. China;
2. Department of Cardiovascular Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400030, P.R. China;

Corresponding author：

PENG Huali, Email: penghuali16@163.com; XIAO Yingbin, Email: xiaoyb@vip.sina.com

Keywords：

Ventricular septal defect; transthoracic device closure; surgical repair under direct vision; complications; meta-analysis

DOI：

10.7507/1007-4848.201609072

Video：

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Objective To compare the effects of transthoracic device closure and surgical closure on ventricular septal defect systemically. Methods A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Chinese Clinical Trial Register, ClinicalTrials. gov and Wanfang Database up to July 31, 2016. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted using RevMan 5.0 and Stata 14.0 software. Results Eleven studies were identified, including 5 RCTs and 6 cohort studies involving 2 504 patients. For success rate, there was no statistical difference between the transthoracic closure group and the surgical closure group in RCT (RR=0.99, 95%CI 0.96 to 1.03, P=0.70); the success rate in the transthoracic closure group was lower than that in the surgical closure group in the cohort study (OR=0.21, 95%CI 0.08 to 0.55, P=0.002). Both results of RCTs and cohort studies showed that compared with surgical closure, transthoracic device closure reduced duration of the operation (RCT MD=–79.38, 95%CI –95.00 to –63.76, P<0.000 01; cohort studyMD=–66.26, 95%CI –71.20 to –61.31, P<0.000 01) and hospital stay (RCTMD=–2.10, 95%CI –2.65 to –1.55, P<0.000 01; cohort studyMD=–3.99, 95%CI –6.03 to –1.94, P=0.000 1), and the patients with blood transfusion (RCT RR= 0.04, 95%CI 0.01 to 0.11, P<0.000 01; cohort studyOR=0.01, 95%CI 0.00 to 0.13, P=0.001). In the transthoracic closure group the risk of postoperative arrhythmia reduced (RCT RR=0.20, 95%CI 0.13 to 0.32, P<0.000 01; cohort studyOR=0.46, 95%CI 0.31 to 0.67, P<0.000 1). In the transthoracic closure group a higher postoperative valvular regurgitation risk in RCT induced (RR=1.45, 95%CI 1.07 to 1.96, P=0.02) and the rate of postoperative valvular regurgitation in cohort study reduced (OR=0.43, 95%CI 0.20 to 0.92, P=0.03). However, there was no statistical difference in postoperative residual shunt (RCT RR=0.96, 95%CI 0.57 to 1.62, P=0.89; cohort study OR=0.52, 95%CI 0.12 to 2.25, P=0.38). Conclusion Transthoracic device closure can shorten duration of the operation, hospital stay and reduce the patients with blood transfusion and post- and intraoperative arrhythmia risk. Therefore, transthoracic device closure may be a better approach for some ventricular septal defect patients.

Citation： ZHOU Yang, LIU Lingxi, ZHAO Fei, TANG Shihai, PENG Huali, XIAO Yingbin. Efficacy of transthoracic device closure versus surgical closure on ventricular septal defects: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 36-44. doi: 10.7507/1007-4848.201609072 Copy

1.	Hazekamp MG, Gomez AA, Koolbergen DR, et al. Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study. Eur J Cardiothorac Surg, 2010, 38(6): 699-706.
2.	Xing Q, Wu Q, Shi L, et al. Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: long-term follow-up results. J Thorac Cardiovasc Surg, 2015, 149(1): 257-264.
3.	张冲, 崔传玉, 何飞, 等. 经胸微创介入封堵治疗室间隔缺损. 中华胸心血管外科杂志, 2014, 30(6): 366-367.
4.	Xu F, Chen DZ, Chen LW, et al. Intraoperative device closure of perimembranous ventricular septal defects: another safe and feasible alternative to surgical repair in infants. Eur J Cardiothorac Surg, 2012, 42(5): 800-805.
5.	Wang X, Zhao TL, Wu Q, et al. Efficacy comparison between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect. Zhonghua Xin Xue Guan Bing Za Zhi, 2012, 40(10): 830-833.
6.	张学勤, 邢泉生, 武钦. 经胸封堵与右腋下小切口直视修补婴幼儿膜周部室间隔缺损的结果对比. 中华胸心血管外科杂志, 2015, 31(9): 527-532.
7.	丁长明. 经胸微创封堵术治疗小儿室间隔缺损的效果分析. 中国继续医学教育, 2015, 7(30): 75-76.
8.	荣敬, 耿潇潇. 小儿先天性心脏病经胸小切口微创封堵术的治疗效果及术后护理经验探析. 医学信息, 2015, 28(47): 157.
9.	程宇, 尹晓清. 经胸小切口室间隔缺损封堵 86 例的临床分析. 中国社区医师, 2015, (24): 17-18.
10.	Chen Q, Cao H, Zhang GC, et al. Closure of perimembranous ventricular septal defects with intraoperative device technique: another safe alternative to surgical repair. Thorac Cardiovasc Surg, 2013, 61(4): 293-299.
11.	李有金, 刘新波, 张亚政, 等. 经胸微创封堵技术在婴幼儿先天性室间隔缺损中的应用观察. 宁夏医学杂志, 2015, 37(12): 1148-1150.
12.	陆国梁. 经胸微创封堵术与外科手术治疗室间隔缺损的对照研究. 广州医科大学, 2015.
13.	Amin Z, Berry JM, Foker JE, et al. Intraoperative closure of muscular ventricular septal defect in a canine model and application of the technique in a baby. J Thorac Cardiovasc Surg, 1998, 115(6): 1374-1376.
14.	Bacha EA, Cao QL, Starr JP, et al. Perventricular device closure of muscular ventricular septal defects on the beating heart: technique and results. J Thorac Cardiovasc Surg, 2003, 126(6): 1718-1723.
15.	Cao H, Chen Q, Zhang GC, et al. Intraoperative device closure of perimembranous ventricular septal defects in the young children under transthoracic echocardiographic guidance; initial experience. J Cardiothorac Surg, 2011, 6: 166.
16.	Zhang GC, Chen Q, Chen LW, et al. Transthoracic echocardiographic guidance of minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: initial experience. Eur Heart J Cardiovasc Imaging, 2012, 13(9): 739-744.
17.	Butera G, Chessa M, Carminati M. Percutaneous closure of ventricular septal defects. Cardiol Young, 2007, 17(3): 243-253.
18.	Walsh MA, Bialkowski J, Szkutnik M, et al. Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart, 2006, 92(9): 1295-1297.

1. Hazekamp MG, Gomez AA, Koolbergen DR, et al. Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study. Eur J Cardiothorac Surg, 2010, 38(6): 699-706.
2. Xing Q, Wu Q, Shi L, et al. Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: long-term follow-up results. J Thorac Cardiovasc Surg, 2015, 149(1): 257-264.
3. 张冲, 崔传玉, 何飞, 等. 经胸微创介入封堵治疗室间隔缺损. 中华胸心血管外科杂志, 2014, 30(6): 366-367.
4. Xu F, Chen DZ, Chen LW, et al. Intraoperative device closure of perimembranous ventricular septal defects: another safe and feasible alternative to surgical repair in infants. Eur J Cardiothorac Surg, 2012, 42(5): 800-805.
5. Wang X, Zhao TL, Wu Q, et al. Efficacy comparison between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect. Zhonghua Xin Xue Guan Bing Za Zhi, 2012, 40(10): 830-833.
6. 张学勤, 邢泉生, 武钦. 经胸封堵与右腋下小切口直视修补婴幼儿膜周部室间隔缺损的结果对比. 中华胸心血管外科杂志, 2015, 31(9): 527-532.
7. 丁长明. 经胸微创封堵术治疗小儿室间隔缺损的效果分析. 中国继续医学教育, 2015, 7(30): 75-76.
8. 荣敬, 耿潇潇. 小儿先天性心脏病经胸小切口微创封堵术的治疗效果及术后护理经验探析. 医学信息, 2015, 28(47): 157.
9. 程宇, 尹晓清. 经胸小切口室间隔缺损封堵 86 例的临床分析. 中国社区医师, 2015, (24): 17-18.
10. Chen Q, Cao H, Zhang GC, et al. Closure of perimembranous ventricular septal defects with intraoperative device technique: another safe alternative to surgical repair. Thorac Cardiovasc Surg, 2013, 61(4): 293-299.
11. 李有金, 刘新波, 张亚政, 等. 经胸微创封堵技术在婴幼儿先天性室间隔缺损中的应用观察. 宁夏医学杂志, 2015, 37(12): 1148-1150.
12. 陆国梁. 经胸微创封堵术与外科手术治疗室间隔缺损的对照研究. 广州医科大学, 2015.
13. Amin Z, Berry JM, Foker JE, et al. Intraoperative closure of muscular ventricular septal defect in a canine model and application of the technique in a baby. J Thorac Cardiovasc Surg, 1998, 115(6): 1374-1376.
14. Bacha EA, Cao QL, Starr JP, et al. Perventricular device closure of muscular ventricular septal defects on the beating heart: technique and results. J Thorac Cardiovasc Surg, 2003, 126(6): 1718-1723.
15. Cao H, Chen Q, Zhang GC, et al. Intraoperative device closure of perimembranous ventricular septal defects in the young children under transthoracic echocardiographic guidance; initial experience. J Cardiothorac Surg, 2011, 6: 166.
16. Zhang GC, Chen Q, Chen LW, et al. Transthoracic echocardiographic guidance of minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: initial experience. Eur Heart J Cardiovasc Imaging, 2012, 13(9): 739-744.
17. Butera G, Chessa M, Carminati M. Percutaneous closure of ventricular septal defects. Cardiol Young, 2007, 17(3): 243-253.
18. Walsh MA, Bialkowski J, Szkutnik M, et al. Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart, 2006, 92(9): 1295-1297.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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

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