Systematic Review and Meta-Analysis of Comparative Studies: Transcatheter Versus Surgical Closure for Postinfarct Ventricular Septal Defect

Abstract

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; I²  = 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; I²  = 63.0%) and PIVSD size (mean difference, −3.94 mm; CI [−6.90, −0.99]; p = 0.09; I²  = 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.