■小儿窦口继发孔型房间隔缺损(ASD)的最佳闭合方法仍不确定。本研究旨在评估手术和经导管封闭的并发症和疗效。
■Medline中的系统搜索,科克伦,和EMBASE数据库确定了队列研究,直到2023年7月。并发症,住院时间,并评估疗效结果。考虑种族的亚组分析,ASD尺寸,年龄,和边缘缺乏症的参与。
■全面分析了14项队列研究,涉及9695名患者。关于并发症,手术组的儿科患者表现出更高的心律失常发生率(比值比[OR]:1.87,95%置信区间[CI]:1.22-2.87,p=0.004),心包积液(OR:14.80,95%CI:6.97-31.43,p<0.00001),与经导管组相比,肺部并发症(OR:2.58,95%CI:1.73-3.85,p<0.00001)。然而,发热发生率无显著差异(OR:2.57,95%CI:0.90-7.34,p=0.08).此外,儿科经导管组的住院时间显著缩短(平均差异[MD]:4.00,95%CI:1.71-6.29,p=0.0006).关于功效,在儿科队列中,两组患者的成功闭合率(OR:1.97,95%CI:0.56~6.92,p=0.29)和残余分流率(OR:0.55,95%CI:0.17~1.77,p=0.31)相似.亚组分析显示,欧洲儿科人群的手术残余分流率明显较低(OR:0.18,95%CI:0.07-0.45,p=0.0002),在ASD大小超过15mm的情况下(OR:0.19,95%CI:0.08-0.49,p=0.0006),和小于8岁的儿科患者(OR:0.33,95%CI:0.12-0.92,p=0.03)。有趣的是,在手术组中,涉及复杂ASD伴边缘缺陷的残余分流更为明显(OR:2.66,95%CI:1.33-5.32,p=0.006)。
■手术和经导管封闭同样有效,经导管封堵术显示并发症明显较少。
结论:这项荟萃分析为临床医生寻求最佳的小儿闭口ASD闭合方法提供了关键的见解。观察到的心律失常发生率较高,心包积液,手术封闭中的肺部并发症突显了与这种方式相关的挑战.相比之下,经导管封堵术,具有相当的疗效和较短的住院时间,成为一种吸引人的、侵入性较小的替代品。这些发现为临床医生提供了做出明智决定的证据,优化患者结果。分组分析进一步完善建议,强调为欧洲儿科患者量身定制的考虑因素,更大的ASD,那些8岁以下的人,最终促进个性化和改进的护理策略。
UNASSIGNED: The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures.
UNASSIGNED: Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement.
UNASSIGNED: Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006).
UNASSIGNED: Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications.
CONCLUSIONS: This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.