A Meta-analysis On Contralled Trial Of Transcatheter Closure And Cardiac Surgery In Patent Ductus Ateriosus

ObjectiveSearch all studies that have been published in the world regard to the controlled trials about transcatheter closure and cardiac surgery in patent ductus arteriosus (PDA) and make synthetic evaluation and quantitative analysis by means of meta-analysis.To evaluate the effectiveness of transcatheter closure,especially by Amplatzer device occlusion on patent ductus arteriosus,in order to give some evidences for the clinical application. MethodsThe procedure including:to set retrieval strategies,collect pertinent studies,determine the absorbing and depleting standard,evaluate all the studies and select suitabl statistical treatment to fulfill the meta-analysis.Search related controlled trials in MEDLINE,EMBASE,CBMA,CNKI,VIP Chinese technology periodical database,WanFang digital journals:thesis full text;Chinese conference full text,English conference full text and CL.Two assessors read the titles and abstracts of pertinent studies respectively,make preliminary screening and choose ideal studies.Then two reviewers extract information and make qualitative analysis independently,discuss or turn to the third reviewer if differences still exist after cross checking.Meta-analysis including:analyze relative risk of procedure failure and the incidence of complication on base of regarding overall transcatheter closure* and cardiac surgery as contrast;analyze relative risk of operation failure,the incidence of complication and serious complication,postoperative redidual shunt,discharge redidual shunt and transfusion on base of regarding Amplatzer device occlusion and cardiac surgery as contrast.Sensitivity analysis according to above relative risk is evaluated respectively. RevMan 4.3 and 4.2.2 software provided by the Cochrane Collaboration was used for statistical analysis.Effect scale of the numeration data is expressed as relative risk(RR) and its 95%confidence interval (CD . Results1 . Totally 26 controlled trials were retrivaled,after excluded 16 studies according to depleting standard,there were 10 studies enrolled in our meta-analysis.Among them 4 trials are English records and 6 trials are Chinese records;5 trials focus on Amplatzer device occlusion versus cardiac surgery , 4 trials focus on coil occlusion versus cardiac surgery, 1 trial focus on Amplatzer device and coil versus cardiac surgery .All studies are non-randomized concurrent control trial(NRCT) .2 . Meta-analysis about overall transcatheter closure and cardiac surgery: operation failure of overall transcatheter therapy is higher than cardiac surgery [10CT,692,2.6%vs0%,RR=4.22,95% CI(1.24,14.32) ]; the incidence of complication of overall transcatheter closure is obviously lower than cardiac surgery[9CT,636,7.6%vs28.9%,RR=0.21,95%CI (0.13,0.35) ].3 . Meta-analysis about Amplatzer device occlusion and cardiac surgery: operation failure of Amplatzer device occlusion is higher than cardiac surgery [5CT,349,3.0%vs0%,RR=4.29,95%CI (0.77,23.95) ]; postoperative redidual shunt is higher than cardiac surgery[4CT,304,16.3%vs0%,RR=16.06,95%CI(3.00,86.12) ] ;because of P is not applicable in heterogeneity test when analyzing discharge redidual shunt which shows heterogeneity is inferior,we give up and just make simple measurement data calculation: discharge redidual shunt is higher than cardiac surgery but there is no significant difference( 2.5%vs0%,p=0.33 ) ; the incidence of complication is obviously lower than cardiac surgery[5CT,343,3.1%vs38%,RR=0.11,95%CI(0.05,0.23) ]; the incidence of serious complication[5CT,343,0.5%vs6.0%,RR=0.23,95%CI (0.06, 0.90) ]; transfusion is obviously lower than cardiac surgery[3CT, 284, 0%vs27.4%, RR=0.05, 95%CI (0.01, 0.25) ].4 . Sensitivity analysis according to above relative risk is evaluated respectively,the result shows preferable reliability of our study. Conclusions1. Although operation failure rate of overall transcatheter closure is higher than cardiac surgery,but lower operation failure would be expected if strictly standardizethe indication and operation;the effect is similar as surgery with lower incidence ofcomplication.2. Although operation failure rate of Amplatzer device occlusion is higher than cardiac surgery,lower operation failure rate would anticipated with the unceasing development of interventional technique and appliance; postoperative redidual shunt is higher than cardiac surgery but discharge redidual shunt is of no significant difference;the incidence of complication and serious complication of Amplatzer device occlusion is obviously lower than cardiac surgery as well as ransfusion.3 . Transcatheter closure of PDA with minimal trauma,low incidence of complication gives no opportunity for surgery to surpass it;for indications with the development of closure divece and delivery mechanism transcatheter closure of PDA is an alternative to cardiac surgery.