Efficacy of echocardiography-guided alone<italic/> versus<italic/> fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wenxin ^1,2 , DONG Xin ³ , ZHANG Xin ^1,2 , XU Jianguo ⁴ , HE Xiaolong ^1,2 , LIU Chengfei ^2,5 , YI Kang ^2,6 ,  YOU Tao ^2,6

1. The First Clinical Medical School of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, 730000, P. R. China;
3. Department of Ultrasound Medicine, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;
4. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, P. R. China;
5. The First Clinical Medical School of Lanzhou University, 730000, P. R. China;
6. Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

YOU Tao, Email: syxzwk@126.com

Keywords：

Atrial septal defect; percutaneous closure; echocardiography; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202112088

Video：

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Objective To systematically evaluate the safety and efficacy of percutaneous closure of atrial septal defect (ASD) guided by echocardiography alone versus fluoroscopy. Methods The databases of PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI from January 2000 to October 2021 were searched by computer for relevant research literature. Two reviewers independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Results A total of 19 cohort studies and 1 randomized controlled study were collected, including 2 825 patients. The Newcastle-Ottawa Scale score for cohort studies was≥7 points. Meta-analysis showed that there was no statistical difference in the operative success rate (RR=1.01, 95%CI 1.00 to 1.02, P=0.17), incidence of occluder displacement/shedding (RR=0.77, 95%CI 0.26 to 2.27, P=0.63), incidence of arrhythmia (RR=0.50, 95%CI 0.21 to 1.14, P=0.10), incidence of pericardial effusion (RR=0.98, 95%CI 0.32 to 2.98, P=0.97), operative time (MD=–0.23, 95%CI –7.56 to 7.10, P=0.95) or cost (SMD=–0.39, 95%CI –1.09 to 0.30, P=0.27) between the two groups. The echocardiography group reduced the incidence of total postoperative complications (RR=0.42, 95%CI 0.30 to 0.60, P<0.001) and residual shunt (RR=0.70, 95%CI 0.50 to 0.98, P=0.04), and shortened length of hospital stay (MD=–0.43, 95%CI –0.77 to 0.09, P=0.01). Conclusion Compared with traditional fluoroscopy-guided percutaneous closure of ASD, echocardiography guidance alone is equivalent in terms of operative success rate, major postoperative complications, operative time and total cost, but it reduces the incidence of total postoperative complications and residual shunt, and has a shorter length of hospital stay.

Citation： WANG Wenxin, DONG Xin, ZHANG Xin, XU Jianguo, HE Xiaolong, LIU Chengfei, YI Kang, YOU Tao. Efficacy of echocardiography-guided alone versus fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1490-1498. doi: 10.7507/1007-4848.202112088 Copy

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2.	Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention, 2011, 7(3): 377-385.
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8.	Hill KD, Frush DP, Han BK, et al. Radiation safety in children with congenital and acquired heart disease: A scientific position statement on multimodality dose optimization From the Image Gently Alliance. JACC Cardiovasc Imaging, 2017, 10(7): 797-818.
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27.	Ackermann S, Quandt D, Hagenbuch N, et al. Transcatheter atrial septal defect closure in children with and without fluoroscopy: A Comparison. J Interv Cardiol, 2019, 2019: 6598637.
28.	蒙茂龍, 劉志紅, 王志偉, 等. 超聲引導經頸靜脈封堵治療房間隔缺損的療效及安全性分析. 現代醫學與健康研究電子雜志, 2019, 3(16): 28-29.
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33.	Li P, Fang F, Qiu X, et al. Personalized three-dimensional printing and echoguided procedure facilitate single device closure for multiple atrial septal defects. J Interv Cardiol, 2020, 2020: 1751025.
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1. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.
2. Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention, 2011, 7(3): 377-385.
3. 移康, 王丹, 尤濤, 等. 經胸封堵與傳統開胸修補治療房間隔缺損療效比較的Meta分析. 中國循證心血管醫學雜志, 2020, 12(12): 1417-1424.
4. Villablanca PA, Briston DA, Rodés-Cabau J, et al. Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis. Int J Cardiol, 2017, 241: 149-155.
5. 許建國, 馬龍, 尤濤, 等. 單純超聲心動圖引導下經皮封堵與經胸封堵治療房間隔缺損療效比較的Meta分析. 中國循證心血管醫學雜志, 2019, 11(12): 1426-1430.
6. 高開柱, 李小波, 李慶國, 等. 四種方法治療繼發孔房間隔缺損的比較. 心肺血管病雜志, 2019, 38(4): 399-402, 408.
7. Karatasakis A, Brilakis HS, Danek BA, et al. Radiation-associated lens changes in the cardiac catheterization laboratory: Results from the IC-CATARACT (CATaracts Attributed to RAdiation in the CaTh lab) study. Catheter Cardiovasc Interv, 2018, 91(4): 647-654.
8. Hill KD, Frush DP, Han BK, et al. Radiation safety in children with congenital and acquired heart disease: A scientific position statement on multimodality dose optimization From the Image Gently Alliance. JACC Cardiovasc Imaging, 2017, 10(7): 797-818.
9. Yang Y, Zhang W, Wu Q, et al. Transcatheter closure of atrial septal defects without fluoroscopy: A well-established procedure for alternative use in children. EuroIntervention, 2016, 12(5): e652-e657.
10. Schubert S, Kainz S, Peters B, et al. Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients. Clin Res Cardiol, 2012, 101(9): 691-700.
11. Li GS, Li HD, Yang J, et al. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims. PLoS One, 2012, 7(12): e51117.
12. Erdem A, Sar?tas T, Zeybek C, et al. Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults. Int J Cardiovasc Imaging, 2013, 29(1): 53-61.
13. 朱達, 周瑩, 劉斌. 經食管實時三維超聲心動圖在心臟外科手術中的應用進展. 中國胸心血管外科臨床雜志, 2011, 18(4): 354-358.
14. Ma LL, Wang YY, Yang ZH, et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better? Mil Med Res, 2020, 7(1): 7.
15. Higgins JP, Altman DG, G?tzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
16. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17. 王鈺, 駱志玲, 潘家華, 等. 非X線下經胸壁超聲全程引導經導管房間隔缺損封堵術的應用研究. 中華超聲影像學雜志, 2009, 18(1): 31-33.
18. 歐陽文斌, 潘湘斌, 逄坤靜, 等. 單純食管超聲引導經皮封堵治療房間隔缺損. 中華實用兒科臨床雜志, 2014, 29(18): 1425-1427.
19. 韋寶敏, 黃艷新, 李志樂, 等. 經胸超聲心動圖引導下行房間隔缺損封堵術治療先天性房間隔缺損的臨床研究. 現代生物醫學進展, 2016, 16(19): 3724-3727.
20. 韓宇. 食管超聲心動圖引導技術在房、室間隔缺損介入封堵術中的應用研究. 鄭州大學, 2016.
21. 陳孔敏. 完全超聲心動圖引導下經皮房間隔缺損封堵術的療效分析. 福建醫科大學, 2017.
22. 董向陽, 李文靜, 陳忠建. 彩色多普勒超聲在房間隔缺損介入封堵術中的應用價值. 保健醫學研究與實踐, 2017, 14(4): 49-51, 55.
23. 趙燁, 陳洪余, 林榮, 等. 經胸超聲心動圖全程引導下房間隔缺損封堵術的臨床應用. 包頭醫學院學報, 2017, 33(2): 13-14.
24. Xu W, Li J, Ye J, et al. Transesophageal echocardiography and fluoroscopy for percutaneous closure of atrial septal defects: A comparative study. Medicine (Baltimore), 2018, 97(43): e12891.
25. 徐瑋澤, 葉菁菁, 李建華, 等. 單純食管超聲心動圖引導經皮房間隔缺損封堵術治療房間隔缺損患兒的療效. 浙江大學學報(醫學版), 2018, 47(3): 244-249.
26. 楊明川. 單純經胸超聲引導經皮介入治療房間隔缺損的臨床研究. 石河子大學, 2018.
27. Ackermann S, Quandt D, Hagenbuch N, et al. Transcatheter atrial septal defect closure in children with and without fluoroscopy: A Comparison. J Interv Cardiol, 2019, 2019: 6598637.
28. 蒙茂龍, 劉志紅, 王志偉, 等. 超聲引導經頸靜脈封堵治療房間隔缺損的療效及安全性分析. 現代醫學與健康研究電子雜志, 2019, 3(16): 28-29.
29. 解曉薇, 步建麗, 郄占軍. 經食道超聲在經股靜脈途徑房間隔缺損介入封堵術中的應用價值. 寧夏醫科大學學報, 2019, 41(2): 189-192.
30. 趙麗麗. 單純經胸超聲引導經皮房間隔缺損封堵術安全性和可行性的研究. 內蒙古醫科大學, 2019.
31. 鄧潤迪, 張鳳文, 謝涌泉, 等. 超聲引導經皮房間隔缺損封堵術治療門診患者的可行性研究. 中國胸心血管外科臨床雜志, 2020, 27(1): 10-13.
32. 郭怡萍. TEE引導經皮封堵與X線下封堵及外科小切口治療房間隔缺損的對比研究. 新鄉醫學院, 2020.
33. Li P, Fang F, Qiu X, et al. Personalized three-dimensional printing and echoguided procedure facilitate single device closure for multiple atrial septal defects. J Interv Cardiol, 2020, 2020: 1751025.
34. 張凌波, 郭寰, 李育東, 等. 繼發孔房間隔缺損經胸實時三維超聲心動圖引導封堵術可行性研究. 中國心血管病研究, 2020, 18(7): 632-634.
35. 王鋒劍, 王仲朝, 張俊奇, 等. 經TEE引導與DSA引導下房間隔缺損介入封堵術的比較研究. 中西醫結合心腦血管病雜志, 2020, 18(13): 2186-2188.
36. 陳銀海. RT-3D-TTE與X線引導下經皮封堵術治療繼發孔房間隔缺損的臨床效果對比. 醫學理論與實踐, 2021, 34(11): 1845-1846.
37. O'Byrne ML, Glatz AC, Sunderji S, et al. Prevalence of deficient retro-aortic rim and its effects on outcomes in device closure of atrial septal defects. Pediatr Cardiol, 2014, 35(7): 1181-1190.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of echocardiography-guided alone versus fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis

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