title: Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis.
abstract: BACKGROUND
  Secundum atrial septal defects (ASDs) are treated by surgical closure (SC) or transcatheter device closure (TCC). Due to a scarcity of data directly comparing these approaches, it remains unclear which is superior. This meta-analysis compares the clinical outcomes of the two treatment options.
  
  
  METHODS
  A literature search was performed in MEDLINE, Embase, PubMed, Google Search, and Cochrane databases for studies directly comparing SC and TCC of ASDs. Outcomes studied were major and minor acute complications, all-cause mortality, residual shunt, reinterventions, and length of stay (LOS). Relative risk (RR), difference in mean (DM) and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method with a fixed effect model. In cases of heterogeneity (defined as I2>25%), random effect models were used. Sensitivity and meta-regression analyses were performed for each outcome.
  
  
  RESULTS
  Of the 1742 manuscripts screened, 26 observational studies fulfilled the inclusion criteria (total n=14,559 patients). TCC was superior to SC for the following outcomes: all-cause mortality (RR, 0.66; 95% CI 0.64-0.99), total complications (RR, 0.48; 95% CI 0.35-0.65), major complications (RR, 0.57; 95% CI 0.40-0.81), minor complications (RR, 0.35; 95% CI 0.23-0.53), and LOS (DM, -2.92; 95% CI -3.25 to (-2.58)). Residual shunts were more common with TCC (RR, 3.35; 95% CI 1.72-6.51). No difference was observed regarding the need of reintervention (RR, 1.45; 95% CI 0.60-3.51). Meta-regression analysis showed that older age increases the risk of death and complications in patients undergoing TCC.
  
  
  CONCLUSIONS
  Though both approaches are effective, TCC is associated with lower mortality, complications, and LOS while SC has a lower rate of residual shunting.
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA. Electronic address: pvillabl@montefiore.org.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Villablanca
authors.affiliation: Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Briston
authors.affiliation: Québec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.affiliation: Department of Cardiology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, NY, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Rao
authors.affiliation: Department of Internal Medicine, St. Barnabas Hospital/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aljoudi
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Aman M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Mohananey
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Tanush
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Makkiya
authors.affiliation: Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
authors.forename: Harish
authors.initials: H
authors.lastname: Ramakrishna
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Pediatric Interventional Cardiology, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, New York, NY, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Montefiore Health System, Albert Einstein University, New York, NY, USA; Pediatric Heart Center, Montefiore Health System, Albert Einstein University, New York, NY, USA.
authors.forename: Giles
authors.initials: G
authors.lastname: Peek
authors.affiliation: Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Ali N
authors.initials: AN
authors.lastname: Zaidi
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods / Q000401:mortality*; D054092:Foramen Ovale, Patent / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D064887:Observational Studies as Topic / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D016896:Treatment Outcome; D065506:Vascular Closure Devices
keywords: Atrial septal defect; Meta-analysis; Surgery; Transcatheter