Efficacy and Safety of Transthoracic Versus Transesophageal Echocardiography for Monitoring Closure of Atrial or Ventricular Septal Defects: A Systematic Review and Meta-Analysis

Purpose

For the repair of atrial/ventricular septal defects (ASD/VSD), transthoracic echocardiography (TTE) is easy to perform, cost-effective, and does not require general anesthesia and intubation. Still, TTE is not universally accepted. To compare efficacy and safety of TTE versus transesophageal echocardiography (TEE) to guide percutaneous ASD/VSD closure.

Methods

PubMed, Embase, and the Cochrane library were searched for articles published from their inception to December 2023. The primary outcome was the procedural success rate. The secondary outcomes were residual shunt, late complications, procedure time, and fluoroscopy time. All meta-analyses were performed using a random-effects model.

Results

Eight studies and 1295 patients were included. There were no significant differences between TTE and TEE regarding the procedural success rate (OR = 1.93, 95% CI: 0.90–4.13, p = 0.092; I² = 52.2%, P_{heterogeneity} = 0.063) and residual shunt rate (OR = 0.81, 95% CI: 0.38–1.76, p = 0.600; I² = 0%, P_{heterogeneity} = 0.518). Compared with TEE, TTE reduced the frequency of late complications (OR = 0.25, 95% CI: 0.14–0.43, p < 0.001; I² = 13.8%, P_{heterogeneity} = 0.326), reduced the procedure time (WMD = −8.92, 95% CI: −12.08, −5.75, p < 0.001; I² = 87.4%, P_{heterogeneity} < 0.001), and reduced the fluoroscopy time (WMD = −5.08, 95% CI: −9.59, −0.56, p = 0.028; I² = 95.6%, P_{heterogeneity} < 0.001). The sensitivity analyses showed that the results of the meta-analyses were robust.

Conclusion

Compared with TEE, TTE showed no differences regarding the rates of success and residual shunt, but there were lower rates of late complications and shorter procedure and fluoroscopy times.