Amplatzer Transcatheter and Surgical Closure for Ostium Secundum Atrial Septal Defects: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

TANG Chao ¹ ,  ZENG Zhi ² , LI Jing ³ , CAO Wenzhai ¹ , HUANG Ping ¹

1. West China School of Clinical Sciences, Sichuan University, Chengdu 610041, China2. West China Hospital, Chengdu 610041, China3.Chinese Evidence-Based Medicine Center/Clinical Epidemiology Resource and Training Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

ZENG Zhi, Email: tommychao_2002@163.com

Keywords：

Amplatzer; Occluder; Transcatheter; Surgery; Ostium secundum atrial septal defects; Systematic review

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Objective 　To determine the efficacy and safety of Amplatzer transcatheter closure and surgical closure for ostium secundum atrial septal defects.
Methods 　MEDLINE (1966-July 2006), EMBASE (1966-July 2006), The Cochrane Library (Issue 2, 2006) and CBMdisc (1979-July 2006) were searched for randomized controlled trials or non-randomized controlled trials. Data were extracted by two reviewers using a specially designed extraction form. The quality of included trials was critically assessed. The Cochrane Collaboration’s RevMan 4.2 software was used for data analysis.
Results 　Sixteen non-RCTs involving 2 043 patients were included. No deaths were reported in 14 trials. The other two trials reported one death respectively in the surgical group. Meta-analysis of 12 trials involving 1 722 patients showed that the procedure success rate for the Amplatzer group was lower than that for the surgical group [WMD:0.95, 95%CI (0.92,0.98)]. Similar results were also found in the complete closure rate in 24-hour follow-up [6 trials involving 1 106 patients, WMD:0.96, 95%CI (0.92 to 1.00)], the complication rate [16 trials involving 1 971 patients, WMD:0.27, 95%CI(0.21 to 0.35)] and the transfusion rate [14 trials involving 1 807 patients, WMD:0.03, 95%CI(0.02 to 0.06)].
Conclusions 　The success rate for Amplatzer device closure of ASD is lower than that of surgical repair. However, the complication rate, length of hospital stay and transfusion rate are lower or shorter for Amplatzer device closure than for surgical repair. Based on appropriate patient selection, Amplatzer closure of ASD is a safe and effective alternative to surgical repair.

Citation： TANG Chao,ZENG Zhi,LI Jing,CAO Wenzhai,HUANG Ping. Amplatzer Transcatheter and Surgical Closure for Ostium Secundum Atrial Septal Defects: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(4): 267-275. doi: Copy

1.	Li T, Wang ZJ, Pan TG, et al. Comparison of Amplatzer occluder versus surgical for atrial septal defects. Chinese Journal of Practical Pediatrics, 2002; 17(10): 616-617.
2.	Ruan J, Cai SJ, Lin RZ, et al. Comparison between Amplatzer septal occluder and surgical closure of secundum atrial septal defect. Journal of Clinical and Experimental Medicine, 2006, 5(6): 686-687.
3.	Yang R, Kong XQ, Sheng YH, et al. Comparison between amplatzer septal occluder and surgical closure of secundum atrial septal defect. China Journal of Modern Medicine, 2003, 13(24): 33-36.
4.	Yang ZW, Dai RP, Zhang GJ, et al. Comparison of efficacy and cost between transcatheter and surgical closure of secundum atrial septal defect. Chinese Journal of Cardiology, 2004; 32(5): 390-393.
5.	Zhao ZN, Wu RZ, Zhao QF, et al. Comparison of transcatheter and surgical closure of atrial septal defect. J Appl Clin Pediatr, 2006; 21(13): 865-866.
6.	Feng BX, Huang XS, Zhang JF, et al. Comparison study between transcatheter closure and surgical repair in over 50-year old patients with secundum atrial septal defect. Chin J Thorac Cardivasc Surg, 2004, 20(3): 139-141.
7.	Guan SF, Pan X, Cui KJ, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect over 50 years of age. Chin J Intervernt Cardiol, 2005, 13(6): 357-360.
8.	Carlgren LE. The incidence of congenital heart disease in children born in Gothenburg 1941-1950. Br Heart J, 1959, 21: 40-50.
9.	Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. 2nd ed. New York: Churchill Livingstone, 1993: 609-644.
10.	King TD, Mills NL. Secundum atrial septal defects: non-operative closure during cardiac catheterization. JAMA, 1976, 235: 2506-2509.
11.	Fischer G, Stieh J, Uebing A, et al. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart, 2003, 89(2): 199-204.
12.	Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
13.	Berger F, Vogel M, Alexi-Meskishvili V, et al. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg, 1999, 118(4): 674-678; discussion 678-680.
14.	Bialkowski J, Karwot B, Szkutnik M, et al. Closure of atrial septal defects in children: surgery versus Amplatzer device implantation. Tex Heart Inst J, 2004, 31(3): 220-223.
15.	Cowley CG, Lloyd TR, Bove EL, et al. Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol, 2001, 88(5): 589-591.
16.	Du ZD, Hijazi ZM, Kleinman CS, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol, 2002, 39(11): 1836-1844.
17.	Durongpisitkul K, Soongswang J, Laohaprasitiporn D, et al. Comparison of atrial septal defect closure using amplatzer septal occluder with surgery. Pediatr Cardiol, 2002, 23(1): 36-40.
18.	Hughes ML, Maskell G, Goh TH, et al. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart, 2002, 88(1): 67-70.
19.	Kim JJ, Hijazi ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit, 2002, 8(12): CR787-791.
20.	Thomson JD, Aburawi EH, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart, 2002, 87(5): 466-469.
21.	Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol, 2006, 47(2): 326-331.
22.	李涛, 王作军, 潘同国, 等. Amplatzer封堵器与心脏直视手术治疗房间隔缺损的比较. 中国实用儿科杂志 2002; 17(10): 616-617.
23.	阮兢, 蔡仕俊, 林茹珠, 等. Amplatzer堵闭器与外科手术治疗继发孔型房间隔缺损的比较. 临床和实验医学杂志, 2006; 5(6): 686-687.
24.	杨荣, 孔祥清, 盛燕辉, 等. 继发孔房间隔缺损的Amplatzer 封闭器介入外科手术治疗的对比研究. 中国现代医学杂志 2003; 13(24): 33-36.
25.	杨振文, 戴汝平, 张戈军, 等. 继发孔型房间隔缺损介入治疗和外科手术的对比分析. 中华心血管杂志, 2001, 32(5): 390-393.
26.	赵子牛，吴蓉洲，赵琦峰, 等. 房间隔缺损介入与外科手术治疗疗效对比. 实用儿科临床杂志, 2006, 21(13): 865-866.
27.	.冯碧霞, 黄新胜, 张镜芳, 等. 50岁以上房间隔缺损介入与外科治疗的对比研究. 中华胸心血管外科杂志, 2004, 20(3): 139-141.
28.	关韶峰，潘新，崔克俭, 等. 50岁以上继发孔型房间隔缺损患者介入治疗和外科手术的对比分析. 中国介入心脏病学杂志, 2005, 13(6): 357-360.
29.	Rao PS. Transcatheter closure of atrial septal defect: are we there yet? J Am Coll Cardiol, 1998, 31(5): 1117-1119.
30.	Hijazi Z, Wang Z, Cao Q, et al. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv, 2001, 52(2): 194-199.
31.	Ewert P, Berger F, Daehnert I, et al. Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation, 2000, 101(8): 847-849.

1. Li T, Wang ZJ, Pan TG, et al. Comparison of Amplatzer occluder versus surgical for atrial septal defects. Chinese Journal of Practical Pediatrics, 2002; 17(10): 616-617.
2. Ruan J, Cai SJ, Lin RZ, et al. Comparison between Amplatzer septal occluder and surgical closure of secundum atrial septal defect. Journal of Clinical and Experimental Medicine, 2006, 5(6): 686-687.
3. Yang R, Kong XQ, Sheng YH, et al. Comparison between amplatzer septal occluder and surgical closure of secundum atrial septal defect. China Journal of Modern Medicine, 2003, 13(24): 33-36.
4. Yang ZW, Dai RP, Zhang GJ, et al. Comparison of efficacy and cost between transcatheter and surgical closure of secundum atrial septal defect. Chinese Journal of Cardiology, 2004; 32(5): 390-393.
5. Zhao ZN, Wu RZ, Zhao QF, et al. Comparison of transcatheter and surgical closure of atrial septal defect. J Appl Clin Pediatr, 2006; 21(13): 865-866.
6. Feng BX, Huang XS, Zhang JF, et al. Comparison study between transcatheter closure and surgical repair in over 50-year old patients with secundum atrial septal defect. Chin J Thorac Cardivasc Surg, 2004, 20(3): 139-141.
7. Guan SF, Pan X, Cui KJ, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect over 50 years of age. Chin J Intervernt Cardiol, 2005, 13(6): 357-360.
8. Carlgren LE. The incidence of congenital heart disease in children born in Gothenburg 1941-1950. Br Heart J, 1959, 21: 40-50.
9. Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. 2nd ed. New York: Churchill Livingstone, 1993: 609-644.
10. King TD, Mills NL. Secundum atrial septal defects: non-operative closure during cardiac catheterization. JAMA, 1976, 235: 2506-2509.
11. Fischer G, Stieh J, Uebing A, et al. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart, 2003, 89(2): 199-204.
12. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
13. Berger F, Vogel M, Alexi-Meskishvili V, et al. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg, 1999, 118(4): 674-678; discussion 678-680.
14. Bialkowski J, Karwot B, Szkutnik M, et al. Closure of atrial septal defects in children: surgery versus Amplatzer device implantation. Tex Heart Inst J, 2004, 31(3): 220-223.
15. Cowley CG, Lloyd TR, Bove EL, et al. Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol, 2001, 88(5): 589-591.
16. Du ZD, Hijazi ZM, Kleinman CS, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol, 2002, 39(11): 1836-1844.
17. Durongpisitkul K, Soongswang J, Laohaprasitiporn D, et al. Comparison of atrial septal defect closure using amplatzer septal occluder with surgery. Pediatr Cardiol, 2002, 23(1): 36-40.
18. Hughes ML, Maskell G, Goh TH, et al. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart, 2002, 88(1): 67-70.
19. Kim JJ, Hijazi ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit, 2002, 8(12): CR787-791.
20. Thomson JD, Aburawi EH, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart, 2002, 87(5): 466-469.
21. Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol, 2006, 47(2): 326-331.
22. 李涛, 王作军, 潘同国, 等. Amplatzer封堵器与心脏直视手术治疗房间隔缺损的比较. 中国实用儿科杂志 2002; 17(10): 616-617.
23. 阮兢, 蔡仕俊, 林茹珠, 等. Amplatzer堵闭器与外科手术治疗继发孔型房间隔缺损的比较. 临床和实验医学杂志, 2006; 5(6): 686-687.
24. 杨荣, 孔祥清, 盛燕辉, 等. 继发孔房间隔缺损的Amplatzer 封闭器介入外科手术治疗的对比研究. 中国现代医学杂志 2003; 13(24): 33-36.
25. 杨振文, 戴汝平, 张戈军, 等. 继发孔型房间隔缺损介入治疗和外科手术的对比分析. 中华心血管杂志, 2001, 32(5): 390-393.
26. 赵子牛，吴蓉洲，赵琦峰, 等. 房间隔缺损介入与外科手术治疗疗效对比. 实用儿科临床杂志, 2006, 21(13): 865-866.
27. .冯碧霞, 黄新胜, 张镜芳, 等. 50岁以上房间隔缺损介入与外科治疗的对比研究. 中华胸心血管外科杂志, 2004, 20(3): 139-141.
28. 关韶峰，潘新，崔克俭, 等. 50岁以上继发孔型房间隔缺损患者介入治疗和外科手术的对比分析. 中国介入心脏病学杂志, 2005, 13(6): 357-360.
29. Rao PS. Transcatheter closure of atrial septal defect: are we there yet? J Am Coll Cardiol, 1998, 31(5): 1117-1119.
30. Hijazi Z, Wang Z, Cao Q, et al. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv, 2001, 52(2): 194-199.
31. Ewert P, Berger F, Daehnert I, et al. Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation, 2000, 101(8): 847-849.

Chinese Journal of Evidence-Based Medicine

Amplatzer Transcatheter and Surgical Closure for Ostium Secundum Atrial Septal Defects: A Systematic Review

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