Percutaneous closure versus surgical repair for ruptured sinus of valsalva aneurysm: A systematic review and meta-analysis

Abstract

ObjectivesRuptured sinus of Valsalva aneurysm (RSVA) often has an abrupt onset, and can chest pain, acute heart failure, and even sudden death. The effectiveness of different treatment modalities remains controversial. Thus, we completed a meta-analysis to evaluate the efficiency and safety of traditional surgery vs. percutaneous closure (PC) for RSVA.MethodsWe carried out a meta-analysis using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science and Technology Journal Database. The primary outcome was comparing in-hospital mortality between the two procedures, and the secondary outcome was documenting postoperative residual shunts, postoperative aortic regurgitation, and length of hospital stay in the two groups. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. This meta-analysis was conducted using Review Manager software (version 5.3).ResultsThe final qualifying studies included 330 patients from 10 trials (123 in the percutaneous closure group, and 207 in the surgical repair group). When PC was compared to surgical repair, there were no statistically significant differences in in-hospital mortality (overall OR: 0.47, 95%CI 0.05–4.31, P = 0.50). However, percutaneous closure did significantly decrease the average length of hospital stay (OR: −2.13, 95% CI −3.05 to −1.20, P < 0.00001) when compared to surgical repair, but there were no significant between-group differences in the rates of postoperative residual shunts (overall OR: 1.54, 95%CI 0.55–4.34, P = 0.41) or postoperative aortic regurgitation (overall OR: 1.54, 95%CI 0.51–4.68, P = 0.45).ConclusionPC may become a valuable alternative to surgical repair for RSVA.

Congestive Heart Failure in an Adolescent With a Ruptured Sinus of Valsalva Aneurysm

“…1 A recent meta-analysis of 330 patients from 10 studies showed that percutaneous transcatheter closure was associated with a shorter length of hospital stay but had no statistically significant differences in in-hospital mortality, incidence rates of postinterventional residual shunts, or aortic regurgitation. 6 A surgical approach for SVA repair in our patient who had worsening heart failure symptoms and a high ectopy burden proved to be the best option because it resulted in a good postoperative outcome.…”

Sinus of Valsalva Aneurysm: Different Modes of Presentation and Techniques of Repair

“…No statistically significant differences were observed in in-hospital mortality, but as expected, percutaneous closure did significantly decrease the average length of hospital stay. Both methods showed similar and low postoperative residual shunts and aortic regurgitation [11]. The second review analyzed the transcatheter method in 407 patients: the success rate of the trancatheter closure was 95.6% with an overall mortality of 0.5%, but 12% of the patients developed complications, the most significant of which were sustained residual shunts in seven, substantial new onset or progression of aortic insufficiency in six and recurrence of SVA in six [12].…”

An observational study of symmetrical VSD occluder for transcatheter closure of ruptured sinus of Valsalva aneurysm

“…However, surgical procedures may result in a high incidence of aortic regurgitation and residual leakage due to invasive injury to the sinus of Valsalva ( 4 ). Therefore, Cullen et al ( 5 ) first conducted transcatheter closure (TCC) of RSVA in 1994, and with the improvement of interventional techniques and the advances in interventional devices, there have been an increasing number of reports on the TCC of RSVA globally ( 6 ). Currently, as far as we know, there is not a specialized occluder for RSVA and the majority of interventional therapies use the Amplatzer ventricular septal defect (VSD) or patent ductus arteriosus (PDA) occluders ( 7-9 ).…”