title: Comparison of percutaneous device closure versus surgical closure of peri-membranous ventricular septal defects: A systematic review and meta-analysis.
abstract: BACKGROUND
  While percutaneous device closure (PDC) is a first-line therapy for isolated muscular ventricular septal defects (mVSD), surgery is still the preferred approach for peri-membranous ventricular septal defects (pmVSD).
  
  
  OBJECTIVE
  We sought to compare the outcomes of percutaneous versus open surgical closure of pmVSDs.
  
  
  METHODS
  PubMed, Cochrane Library, and Web of Science databases were searched through October 15, 2014 for English language studies comparing outcomes of PDC with surgical closure of pmVSDs. Study quality, publication bias, and heterogeneity were assessed. A meta-analysis of selected studies was performed using a random effects model. Comparison was done for early (<1 month) safety and efficacy outcomes.
  
  
  RESULTS
  Seven studies with a total of 3,134 patients (PDC = 1,312, surgery = 1,822) were identified. Patients in the PDC group were older than those treated surgically (mean age 12.2 vs. 5.5 years, respectively). In six out of seven studies, the mean VSD size was found to be comparable between the treatment arms (PDC 4.9 mm vs. surgery 6.0 mm). Males represented 52% of patients in either group. Follow-up ranged from 5 to 42 months. No significant differences were observed between PDC vs. surgery in terms of procedural success rate [relative risk (RR): 1.00, confidence interval (CI): 0.99-1.00; P = 0.67]. Combined safety end points for major complications (early death/reoperation/permanent pacemaker) were similar in both groups (RR: 0.55, CI: 0.23-1.35; P = 0.19) as were as other outcomes like post-procedure significant residual shunt (RR: 0.69, CI: 0.29-1.68; P = 0.41), significant valvular (aortic/tricuspid) regurgitation (RR: 0.70, CI: 0.26-1.86; P = 0.47), and advanced heart block (RR: 0.99, CI: 0.46-2.14; P = 0.98). The need for blood transfusion (RR: 0.02, CI: 0.00-0.05; P < 0.001) and duration of hospital stay [standard mean difference (SMD) -2.17 days, CI: -3.12 to -1.23; P < 0.001] were significantly reduced in the PDC group.
  
  
  CONCLUSIONS
  Percutaneous closure of pmVSD when performed in a selected subgroup of patients is associated with similar procedural success rate without increased risk of significant valvular regurgitation or heart block when compared with surgical closure.
authors.affiliation: Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Alok
authors.initials: A
authors.lastname: Saurav
authors.affiliation: Division of Cardiology, VA Nebraska-Western Iowa Health System, Omaha, Nebraska.
authors.forename: Manu
authors.initials: M
authors.lastname: Kaushik
authors.affiliation: Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Venkata
authors.initials: V
authors.lastname: Mahesh Alla
authors.affiliation: Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Michael D
authors.initials: MD
authors.lastname: White
authors.affiliation: Division of Cardiology, Alegent Creighton Heart and Vascular Institute, Omaha, Nebraska.
authors.forename: Ruby
authors.initials: R
authors.lastname: Satpathy
authors.affiliation: Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lanspa
authors.affiliation: Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Aryan N
authors.initials: AN
authors.lastname: Mooss
authors.affiliation: Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Michael G
authors.initials: MG
authors.lastname: DelCore
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D008297:Male; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome
keywords: percutaneous closure of VSDs; peri-membranous ventricular septal defect; surgical closure of VSDs; ventricular septal defect