Key result
Combining PFO/ASD and LAA closure yields similar procedural success and safety to LAA closure alone.
Why the study?
The feasibility and safety of combined left atrial appendage and ASD/PFO closure remained unclear, with previous studies limited by small sample sizes and retrospective designs.
Does combining PFO/ASD occlusion and LAA closure maintain procedural feasibility and safety compared to single LAA closure?
Meta-Analysis (n=340)
Yes
Does combining PFO/ASD occlusion and LAA closure maintain procedural feasibility and safety compared to single LAA closure?
Combining PFO/ASD occlusion and LAA closure is technically feasible and safe, with procedural success and complication rates comparable to single LAA closure.
Answers are grounded in this paper and cite their sources.
May support combined closure when indicated; leaves open need for randomized confirmation of long-term outcomes.
Introduction: Atrial Septal Defect/Patent Foramen Ovale (ASD/PFO) occlusion is performed to prevent paradoxical embolism and reduce the risk of recurrent ischemic stroke. Left atrial appendage (LAA) closure is used as an alternative to medical therapy of non-valvular atrial fibrillation for prevention of stroke. Multiple studies have examined performing LAA and ASD/PFO occlusion. However, the feasibility and safety of combined occlusion of the left atrial appendage and ASD/PFO are not clear, furthermore, these studies are limited by their small sample sizes and retrospective analysis. In this study, we aimed to systematically review and meta-analyze the feasibility and safety of combining left atrial appendage and ASD/PFO closure. Methods: PubMed, Web of Science, CNKI, Cochrane Library, Embase, and WanFang database were searched up to April 2022 to identify peer-reviewed human studies on assessing the feasibility, safety, and efficacy of combining left atrial appendage and ASD/PFO closure. The primary outcome was calculated: procedural feasibility outcome and procedural safety outcome. Results: A total of 10 articles, including 340 patients from multiple countries, were included in the analysis. The principal findings of our study are: compared with single LAA closure, (i) combining PFO/ASD occlusion and LAA closure had similar procedural success proportion (98.43%, 95% CI: 96.67-100.00%), (ii) similar safety event incidences developed (1.67%, 95% CI: 0.24-3.92%), subgroup analyzed safety event incidences in death was 0.00 (95% CI: 0.00-0.33%), cardiac tamponade was 0.87% (95% CI: 0.00-2.77%), device embolization was 0.00 (95% CI: 0.00-0.60%), major bleeding was 0.00 (95% CI: 0.00-0.33%), stroke was 0.00 (95% CI: 0.00-0.02%). Conclusion: Although this systematic review and meta-analysis demonstrate the technical feasibility and safety of combining closure of PFO/ASD and LAA, further studies of sufficient sample size, long-term follow-up, and rigor endpoint criteria are yet needed to fully evaluate this combination procedure for its role in clinical outcomes.
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Song et al. (2023) conducted a meta-analysis in Patients undergoing combined left atrial appendage and atrial septal defect/patent foramen ovale closure (n=340). Combined PFO/ASD occlusion and LAA closure vs. Single LAA closure was evaluated on Procedural success proportion (95% CI 96.67-100.00, p=0.6742). Combining PFO/ASD occlusion and LAA closure demonstrated a high procedural success proportion of 98.43% and a low safety event incidence of 1.67%, which were not significantly different from single LAA closure.
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