Anatolian Journal of Cardiology最新文献

Background: Atrial septal defect closure can be performed surgically or via transcatheter intervention, yet comparative outcomes remain inconsistent between children and adults. This review synthesizes observational evidence to evaluate procedural success, complications, and periprocedural characteristics across both populations.

Methods: A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was conducted, including 36 observational studies published through 2024. Study quality was assessed using the Newcastle-Ottawa Scale. Random effects models were applied, with subgroup analyses by age and procedure type. Publication bias was examined using funnel plots and Egger's test.

Results: The pooled procedural success rate was 95% (95% CI: 92%-97%; I² = 90.2%). Among children, raw procedural success was 87% (1445/1656) for transcatheter closure and 99% (505/510) with surgery. In adults, transcatheter closure achieved 97% (95% CI: 90%-99%), whereas surgery reached 98% (95% CI: 70%-100%). Transcatheter closure resulted in shorter hospitalization (mean difference: -3.86 days, 95% CI: -6.03 to -1.69; P = .0004) and fewer major complications (risk ratio: 0.58, 95% CI: 0.39-0.86; P = .006). Sensitivity analysis restricted to high-quality studies (n = 12) remained consistent. Egger's regression did not indicate significant publication bias (P = .069).

Conclusion: Both approaches provide high closure success, yet transcatheter intervention offers lower complication rates and faster recovery, particularly in anatomically suitable patients. These findings support individualized treatment selection based on age, anatomy, and institutional experience.

Background: This study assessed the efficacy and tolerability of the oral prostacyclin receptor agonist selexipag as part of sequential triple combination therapy in patients with pulmonary arterial hypertension (PAH).

Methods: The study retrospectively analyzed 127 of 1160 PAH patients from a single-center registry who received sequential triple therapy including selexipag. Clinical, echocardiographic, and hemodynamic variables and multiparametric risk scores (MRS) were evaluated to assess changes in risk and outcomes.

Results: The mean age was 43.2 ± 16.4 years, and 84.3% were female. Prior to selexipag initiation, Comparative Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension 2.0 risk strata were: 15% first, 31.5% second, 44.1% third, and 9.4% fourth; European Society of Cardiology/European Respiratory Society low-, intermediate-, and high-risk rates were 20.5%, 61.4%, and 18.1%, respectively. Mean REVEAL Lite 2.0 score was 6.3 ± 2.7. Maximal selexipag dosing reached 1600 μg BID in 18.1% of patients, while 64.6% remained at ≤1000 μg BID. Patients were grouped into low-, intermediate-, and high-dose cohorts. Median follow-up was 727.5 days (interquartile range (IQR) 224-985). Selexipag was discontinued in 15% of patients. Across dosing cohorts, initial improvements in functional class, 6-minute walk distance, right ventricular and pulmonary echocardiographic parameters, and MRSs during the first year attenuated thereafter, except for N-terminal pro-brain natriuretic peptide and Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio. Lower baseline REVEAL Lite 2.0 score predicted low-risk status at final assessment (P = .017). Three-year survival was 72.5%, 85.7%, and 75.1% in low-, medium-, and high-dose cohorts (P > .05). Mortality was independently predicted by baseline Swedish PAH Registry, REVEAL 2.0, REVEAL Lite 2.0, and REVEAL Echo scores.

Conclusion: Earlier escalation to triple therapy with selexipag may improve outcomes. Baseline risk-but not achieved selexipag dose-was associated with survival. A possible decline in treatment effect after 1 year warrants further investigation.