Key result
A deficient rim during percutaneous atrial septal defect closure was associated with higher implant failure compared to a sufficient rim (5.43% vs 3.30%; OR 2.27; 95% CI 1.34-3.83; p=0.002).
Why the study?
To compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims during ostium secundum atrial septal defect closure.
Does percutaneous closure of ostium secundum atrial septal defect in patients with deficient rims increase implant failure and adverse events compared to those with sufficient rims?
Meta-Analysis (n=4,355)
Does percutaneous closure of ostium secundum atrial septal defect in patients with deficient rims increase implant failure and adverse events compared to those with sufficient rims?
Percutaneous closure of ostium secundum ASD in patients with deficient rims, particularly posteroinferior, is associated with a higher risk of implant failure compared to those with sufficient rims.
Acceptable failure rates support occlusion despite deficient rims; extends evidence base to 4355 patients in pooled analysis.
BACKGROUND: The aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. METHODS: with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. RESULTS: The systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53-4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35-6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62-3.97%), OR 2.27 CI 1.34-3.83 (p 0.002). The combined adverse events were 5.19% CI 95% 4.22-6.35% vs 2.7% CI 95% 2.08-3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93-5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. CONCLUSION: Patients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.
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Contreras et al. (2023) conducted a meta-analysis in Ostium secundum type atrial septal defect (n=4,355). Deficient rim vs. Sufficient rim was evaluated on Implant failure (OR 2.27, 95% CI 1.34-3.83, p=0.002). A deficient rim during percutaneous atrial septal defect closure was associated with higher implant failure compared to a sufficient rim (5.43% vs 3.30%; OR 2.27; 95% CI 1.34-3.83; p=0.002).
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