Key result
Transcatheter closure for post-infarction ventricular septal defect achieved a pooled successful device implantation rate of 89.7% and a 30-day mortality rate of 31.5%.
Why the study?
Post-infarction ventricular septal defect is a severe complication of acute myocardial infarction, and published evidence on transcatheter closure as an alternative to surgical repair required objective synthesis.
Does transcatheter closure improve survival and shunt reduction in patients with post-infarction ventricular septal defect?
Meta-Analysis (n=462)
Does transcatheter closure improve survival and shunt reduction in patients with post-infarction ventricular septal defect?
Transcatheter closure for post-infarction ventricular septal defect demonstrates a high device implantation success rate (89.7%) and an acceptable 30-day mortality (31.5%), though evidence is limited to non-randomized studies.
Supports feasibility of transcatheter closure in post-infarction VSD; leaves open need for randomized trials versus surgery.
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.
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Yang et al. (2020) conducted a meta-analysis in Post-infarction ventricular septal defect (PIVSD) (n=462). Transcatheter closure (TCC) was evaluated on Successful device implantation (95% CI 0.772-1.021). Transcatheter closure for post-infarction ventricular septal defect achieved a pooled successful device implantation rate of 89.7% and a 30-day mortality rate of 31.5%.
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