Amplatzer Transcatheter And Surgical Closure For Ostium Secundum Atrial Septal Defects: A Systematic Review

Objective: To determine the efficacy and safety of Amplatzer transcatheter closure and surgical closure for ostium secundum atrial septal defects.Methods: MEDLINE(1966-July 2006), EMBASE(1966-July 2006), The Cochrane Library(Issue 2,2006) and CBMdisc(1979-July 2006) were searched for randomized controlled trials or non-randomized controlled trials. Data were extracted by two reviewers using a designed extraction form. The quality of included trials was critically assessed. RavMan4.2 software was used for data analysis.Results: Sixteen Non-RCTs 2043 cases were included.①The death rate of fourteen trials was zero, only two trials reported 1 death in surgical group respectively.②The procedure success rate of Amplatzer group was nearly equal to that of surgical group [WMD:0.95, 95%CI (0.92,0.98)].③The complete closure rate in 24-hour follow-up of Amplatzer group was also nearly equal to that of surgical group [WMD:0.96, 95%CI (0.92,1.00)].④The residual shunts rate of Amplatzer group in 24-hour was higher than that of surgical group [WMD:4.17, 95%CI (2.20,7.93)].⑤The major complication rate of Amplatzer group was lower than that of surgical group [WMD:0.27, 95%CI (0.15,0.47)].⑥The minor complication rate of Amplatzer group was lower than that of surgical group [WMD:0.28, 95%CI (0.21,0.37)].⑦The transfusion rate in Amplatzer group was much lower than that of surgical group [WMD:0.03, 95%CI(0.02, 0.06)].Conclusions: The efficacy success rates for Amplatzer device closure of ASD were not statistically different; however, the complication rate was lower, the length of hospital stay was shorter and the transfusion rate was lower for Amplatzer device closure than for surgical repair. Based on appropriate patient selection, Amplatzer closure of ASD is a safe and effective alternative to surgical repair.