Transcatheter closure for post-infarction ventricular septal defect: A
meta-analysis of the current evidence
Abstract
Objective: Post-infarction ventricular septal defect (PIVSD) is a severe
complication of acute myocardial infarction. Transcatheter closure (TCC)
perform an alternative option to the surgical repair. This study was
undertaken to examine the published literature to give the objective
evidence of TCC using a meta-analysis. Methods: We searched for
significant medical and publishers’ databases. Two reviewers checked the
quality of studies and extracted data. Eligible studies included
single-arm studies and comparative studies. Weighted mean, pooled event
rates, efficacy outcomes and odds ratios(OR) for immediate shunt
reduction(ISR), presence of cardiogenic shock (CS), New York Heart
Association ( NYHA) class IV, time from AMI to ventricular septal
defect(VSD), time to VSD closure was estimated. Results: 27 single arm
articles (462 patients) were included. The pooled event rate was 89.7%
(95%CI: 0.772-1.021) for successful device implantation, 80.9%
(95%CI: 0.645-0.972) for ISR, 31.5% (95%CI of 0.149-0.482) for 30-day
mortality, 25.3% (95%CI: 0.072-0.434) for 30-day mortality of primary
closure at acute phase. CS (OR=3.607, 95%CI: 2.301-5.653), NYHA class
IV (OR=6.491, 95%CI: 1.444-29.188) and time to VSD closure are risk
predictor for TCC. There is no correlation between the defect size
(OR=2.592, 95%CI: 0.380-17.661) and mortality. Conclusion: TCC should
be a relatively safe and low invasive method for PIVSD, with an
excellent successful device implantation rate and acceptable low 30-day
mortality. The procedure appears promising, but its safety and efficacy
could only be demonstrated by randomized controlled trials. Therefore,
they are needed more investigations to determine whether the acute phase
or chronic phase to practice the procedure.