Transcatheter closure for postinfarction ventricular septal defect: A meta‐analysis of the current evidence

Abstract

Objective: Postinfarction ventricular septal defect (PIVSD) is a severe complication of acute myocardial infarction (AMI). Transcatheter closure (TCC) is an alternative option to surgical repair. This study was undertaken to examine the published literature to provide objective evidence for TCC using a meta-analysis. Methods:We searched for significant medical and publisher databases. Two reviewers checked the quality of the studies and extracted data. Eligible studies included single-arm studies and comparative studies. Weighted means, pooled event rates, efficacy outcomes and odds ratios (ORs) for immediate shunt reduction (ISR), presence of cardiogenic shock (CS), New York Heart Association (NYHA) class IV, time from AMI to ventricular septal defect (VSD), and time to VSD closure was estimated.Results: A total of 27 single-arm articles (462 patients) were included. The pooled event rate was 89.7% (95% confidence interval [CI]: 0.772-1.021) for successful device implantation, 80.9% (95% CI: 0.645-0.972) for ISR, 31.5% (95% CI: 0.149-0.482) for 30-day mortality, and 25.3% (95% CI: 0.072-0.434) for 30-day mortality of primary closure at the acute phase. CS (OR = 3.607, 95% CI: 2.301-5.653), NYHA class IV (OR = 6.491, 95% CI: 1.444-29.188) and time to VSD closure were risk predictors for TCC. There was no correlation between defect size (OR = 2.592, 95% CI: 0.380-17.661) and mortality. Conclusion:TCC should be a relatively safe and minimally invasive method for PIVSD, with an excellent successful device implantation rate and acceptable low 30-day mortality. The procedure appears promising, but its safety and efficacy could only be demonstrated by randomized controlled trials. Therefore, the mortality of data comparing surgery to TCC compels the need for future comparative trials.

The Interventricular Septum: Structure, Function, Dysfunction, and Diseases

“…Moreover, it has been recently demonstrated that transcatheter device closure of perimembranous VSD and intracristal VSD can be performed safely and successfully in selected patients with excellent medium- and long-term results [ 88 ]. Interestingly, repair of post-MI septal rupture with transcatheter defect closure emerges as a viable option [ 89 ].…”

Przypadek kliniczny pacjenta z niedokrweinnym ubytkiem w przegrodzie międzykomorowej. Czy istnieje możliwość wyjścia z tego impasu?

“…Transcatheter closure of post-infarct VSD could be an encouraging alternative treatment method that is less invasive and advocated by national guidelines [5]. Although an absence of firm tissue to seat the device for significant defects may be problematic [6]. Post-infarct VSD is usually diverse in shape, which may change throughout the cardiac cycle and could be accompanied by septal rupture [7], which led in the present case to the decision of surgical intervention.…”

“…A repeat transesophageal echocardiography demonstrated no residual shunt. Izabela Warchoł et al, A case study of post-myocardial infarction ventricular septal defect of advanced age and surgical expertise that is not easily accessible [6].…”

Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe

“…Conservative treatment was adopted in a few patients (mostly LVFWR), with a mortality exceeding 90%, confirming previous data [ 13 ]. On the other hand, percutaneous treatment was adopted most often in VSR patients, showing that alternative therapeutic strategies are progressively finding their space for selected patients, although results were slightly suboptimal, if compared to surgery [ 29 ].…”