Does transcatheter closure reduce short-term mortality compared to surgical closure in patients with postinfarct ventricular septal defect?
Transcatheter closure of postinfarct ventricular septal defect yields similar short-term mortality to surgical closure, though with a higher risk of residual shunt or reintervention, making it a viable option for smaller defects.
Background: Postinfarct ventricular septal defect (PIVSD) is a serious complication of acute myocardial infarction (AMI). Transcatheter closure is a potential alternative to surgical closure for PIVSD patients. Objective: This meta‐analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD. Methods: A systemic search of PubMed and Embase until January 2023 identified studies comparing transcatheter versus surgical PIVSD closure. Primary outcomes included short‐term mortality. Short‐term mortality referred to the number of in‐hospital or 30‐day deaths. Secondary outcomes comprised residual shunt/reintervention incidence, difference in time from AMI or PIVSD diagnosis to intervention, the presence of cardiogenic shock, incidence of perioperative mechanical support, PIVSD size difference, and overall mortality at follow‐up. Results: Seven studies comprising 603 patients were included. Short‐term mortality (OR, 1.30; 95% CI 0.90, 1.89; p = 0.17; I 2 = 3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33–9.59; p = 0.01; I 2 = 63.0%) and PIVSD size (mean difference, −3.94 mm; CI −6.90, −0.99; p = 0.09; I 2 = 83.0%) were significantly different; however, the other secondary outcomes were not significantly different. Conclusion: Transcatheter and surgical closure demonstrate similar short‐term mortality. Despite a higher incidence of residual shunt or reintervention in transcatheter closure, it may be a viable option in patients with small size of PIVSD.
Yamaguchi et al. (Mon,) studied this question.