Efficacy of echocardiography-guided alone<italic/> versus<italic/> fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wenxin ^1,2 , DONG Xin ³ , ZHANG Xin ^1,2 , XU Jianguo ⁴ , HE Xiaolong ^1,2 , LIU Chengfei ^2,5 , YI Kang ^2,6 ,  YOU Tao ^2,6

1. The First Clinical Medical School of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, 730000, P. R. China;
3. Department of Ultrasound Medicine, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;
4. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, P. R. China;
5. The First Clinical Medical School of Lanzhou University, 730000, P. R. China;
6. Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

YOU Tao, Email: syxzwk@126.com

Keywords：

Atrial septal defect; percutaneous closure; echocardiography; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202112088

Video：

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Objective To systematically evaluate the safety and efficacy of percutaneous closure of atrial septal defect (ASD) guided by echocardiography alone versus fluoroscopy. Methods The databases of PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI from January 2000 to October 2021 were searched by computer for relevant research literature. Two reviewers independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Results A total of 19 cohort studies and 1 randomized controlled study were collected, including 2 825 patients. The Newcastle-Ottawa Scale score for cohort studies was≥7 points. Meta-analysis showed that there was no statistical difference in the operative success rate (RR=1.01, 95%CI 1.00 to 1.02, P=0.17), incidence of occluder displacement/shedding (RR=0.77, 95%CI 0.26 to 2.27, P=0.63), incidence of arrhythmia (RR=0.50, 95%CI 0.21 to 1.14, P=0.10), incidence of pericardial effusion (RR=0.98, 95%CI 0.32 to 2.98, P=0.97), operative time (MD=–0.23, 95%CI –7.56 to 7.10, P=0.95) or cost (SMD=–0.39, 95%CI –1.09 to 0.30, P=0.27) between the two groups. The echocardiography group reduced the incidence of total postoperative complications (RR=0.42, 95%CI 0.30 to 0.60, P<0.001) and residual shunt (RR=0.70, 95%CI 0.50 to 0.98, P=0.04), and shortened length of hospital stay (MD=–0.43, 95%CI –0.77 to 0.09, P=0.01). Conclusion Compared with traditional fluoroscopy-guided percutaneous closure of ASD, echocardiography guidance alone is equivalent in terms of operative success rate, major postoperative complications, operative time and total cost, but it reduces the incidence of total postoperative complications and residual shunt, and has a shorter length of hospital stay.

Citation： WANG Wenxin, DONG Xin, ZHANG Xin, XU Jianguo, HE Xiaolong, LIU Chengfei, YI Kang, YOU Tao. Efficacy of echocardiography-guided alone versus fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1490-1498. doi: 10.7507/1007-4848.202112088 Copy

1.	Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.
2.	Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention, 2011, 7(3): 377-385.
3.	移康, 王丹, 尤涛, 等. 经胸封堵与传统开胸修补治疗房间隔缺损疗效比较的Meta分析. 中国循证心血管医学杂志, 2020, 12(12): 1417-1424.
4.	Villablanca PA, Briston DA, Rodés-Cabau J, et al. Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis. Int J Cardiol, 2017, 241: 149-155.
5.	许建国, 马龙, 尤涛, 等. 单纯超声心动图引导下经皮封堵与经胸封堵治疗房间隔缺损疗效比较的Meta分析. 中国循证心血管医学杂志, 2019, 11(12): 1426-1430.
6.	高开柱, 李小波, 李庆国, 等. 四种方法治疗继发孔房间隔缺损的比较. 心肺血管病杂志, 2019, 38(4): 399-402, 408.
7.	Karatasakis A, Brilakis HS, Danek BA, et al. Radiation-associated lens changes in the cardiac catheterization laboratory: Results from the IC-CATARACT (CATaracts Attributed to RAdiation in the CaTh lab) study. Catheter Cardiovasc Interv, 2018, 91(4): 647-654.
8.	Hill KD, Frush DP, Han BK, et al. Radiation safety in children with congenital and acquired heart disease: A scientific position statement on multimodality dose optimization From the Image Gently Alliance. JACC Cardiovasc Imaging, 2017, 10(7): 797-818.
9.	Yang Y, Zhang W, Wu Q, et al. Transcatheter closure of atrial septal defects without fluoroscopy: A well-established procedure for alternative use in children. EuroIntervention, 2016, 12(5): e652-e657.
10.	Schubert S, Kainz S, Peters B, et al. Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients. Clin Res Cardiol, 2012, 101(9): 691-700.
11.	Li GS, Li HD, Yang J, et al. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims. PLoS One, 2012, 7(12): e51117.
12.	Erdem A, Sarıtas T, Zeybek C, et al. Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults. Int J Cardiovasc Imaging, 2013, 29(1): 53-61.
13.	朱达, 周莹, 刘斌. 经食管实时三维超声心动图在心脏外科手术中的应用进展. 中国胸心血管外科临床杂志, 2011, 18(4): 354-358.
14.	Ma LL, Wang YY, Yang ZH, et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better? Mil Med Res, 2020, 7(1): 7.
15.	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
16.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17.	王钰, 骆志玲, 潘家华, 等. 非X线下经胸壁超声全程引导经导管房间隔缺损封堵术的应用研究. 中华超声影像学杂志, 2009, 18(1): 31-33.
18.	欧阳文斌, 潘湘斌, 逄坤静, 等. 单纯食管超声引导经皮封堵治疗房间隔缺损. 中华实用儿科临床杂志, 2014, 29(18): 1425-1427.
19.	韦宝敏, 黄艳新, 李志乐, 等. 经胸超声心动图引导下行房间隔缺损封堵术治疗先天性房间隔缺损的临床研究. 现代生物医学进展, 2016, 16(19): 3724-3727.
20.	韩宇. 食管超声心动图引导技术在房、室间隔缺损介入封堵术中的应用研究. 郑州大学, 2016.
21.	陈孔敏. 完全超声心动图引导下经皮房间隔缺损封堵术的疗效分析. 福建医科大学, 2017.
22.	董向阳, 李文静, 陈忠建. 彩色多普勒超声在房间隔缺损介入封堵术中的应用价值. 保健医学研究与实践, 2017, 14(4): 49-51, 55.
23.	赵烨, 陈洪余, 林荣, 等. 经胸超声心动图全程引导下房间隔缺损封堵术的临床应用. 包头医学院学报, 2017, 33(2): 13-14.
24.	Xu W, Li J, Ye J, et al. Transesophageal echocardiography and fluoroscopy for percutaneous closure of atrial septal defects: A comparative study. Medicine (Baltimore), 2018, 97(43): e12891.
25.	徐玮泽, 叶菁菁, 李建华, 等. 单纯食管超声心动图引导经皮房间隔缺损封堵术治疗房间隔缺损患儿的疗效. 浙江大学学报(医学版), 2018, 47(3): 244-249.
26.	杨明川. 单纯经胸超声引导经皮介入治疗房间隔缺损的临床研究. 石河子大学, 2018.
27.	Ackermann S, Quandt D, Hagenbuch N, et al. Transcatheter atrial septal defect closure in children with and without fluoroscopy: A Comparison. J Interv Cardiol, 2019, 2019: 6598637.
28.	蒙茂龙, 刘志红, 王志伟, 等. 超声引导经颈静脉封堵治疗房间隔缺损的疗效及安全性分析. 现代医学与健康研究电子杂志, 2019, 3(16): 28-29.
29.	解晓薇, 步建丽, 郄占军. 经食道超声在经股静脉途径房间隔缺损介入封堵术中的应用价值. 宁夏医科大学学报, 2019, 41(2): 189-192.
30.	赵丽丽. 单纯经胸超声引导经皮房间隔缺损封堵术安全性和可行性的研究. 内蒙古医科大学, 2019.
31.	邓润迪, 张凤文, 谢涌泉, 等. 超声引导经皮房间隔缺损封堵术治疗门诊患者的可行性研究. 中国胸心血管外科临床杂志, 2020, 27(1): 10-13.
32.	郭怡萍. TEE引导经皮封堵与X线下封堵及外科小切口治疗房间隔缺损的对比研究. 新乡医学院, 2020.
33.	Li P, Fang F, Qiu X, et al. Personalized three-dimensional printing and echoguided procedure facilitate single device closure for multiple atrial septal defects. J Interv Cardiol, 2020, 2020: 1751025.
34.	张凌波, 郭寰, 李育东, 等. 继发孔房间隔缺损经胸实时三维超声心动图引导封堵术可行性研究. 中国心血管病研究, 2020, 18(7): 632-634.
35.	王锋剑, 王仲朝, 张俊奇, 等. 经TEE引导与DSA引导下房间隔缺损介入封堵术的比较研究. 中西医结合心脑血管病杂志, 2020, 18(13): 2186-2188.
36.	陈银海. RT-3D-TTE与X线引导下经皮封堵术治疗继发孔房间隔缺损的临床效果对比. 医学理论与实践, 2021, 34(11): 1845-1846.
37.	O'Byrne ML, Glatz AC, Sunderji S, et al. Prevalence of deficient retro-aortic rim and its effects on outcomes in device closure of atrial septal defects. Pediatr Cardiol, 2014, 35(7): 1181-1190.
38.	移康, 许建国, 尤涛, 等. 放射线引导经皮封堵与超声引导经胸封堵治疗房间隔缺损疗效比较的Meta分析. 心肺血管病杂志, 2019, 38(5): 573-580.
39.	肖家旺, 朱鲜阳. 中国先天性心脏病介入治疗发展历程. 协和医学杂志, 2021, 12(3): 303-308.
40.	温朝阳, 李越, 王廉一, 等. 超声引导Amplatzer封堵器关闭房间隔缺损的初步体会. 中华超声影像学杂志, 1999, 8(5): 26-28.
41.	García-Fuertes D, Mesa-Rubio D, Ruiz-Ortiz M, et al. Monitoring complex secundum atrial septal defects percutaneous closure with real time three-dimensional echocardiography. Echocardiography, 2012, 29(6): 729-734.
42.	Pan XB, Ou-Yang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol, 2015, 28(4): 390-395.
43.	Bartel T, Müller S. Contemporary echocardiographic guiding tools for device closure of interatrial communications. Cardiovasc Diagn Ther, 2013, 3(1): 38-46.
44.	Price MJ, Smith MR, Rubenson DS. Utility of on-line three-dimensional transesophageal echocardiography during percutaneous atrial septal defect closure. Catheter Cardiovasc Interv, 2010, 75(4): 570-577.
45.	周奇, 韩宇, 宋书波, 等. 微创封堵治疗房间隔缺损的临床进展. 中国胸心血管外科临床杂志, 2021, 28(12): 1508-1512.
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1. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.
2. Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention, 2011, 7(3): 377-385.
3. 移康, 王丹, 尤涛, 等. 经胸封堵与传统开胸修补治疗房间隔缺损疗效比较的Meta分析. 中国循证心血管医学杂志, 2020, 12(12): 1417-1424.
4. Villablanca PA, Briston DA, Rodés-Cabau J, et al. Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis. Int J Cardiol, 2017, 241: 149-155.
5. 许建国, 马龙, 尤涛, 等. 单纯超声心动图引导下经皮封堵与经胸封堵治疗房间隔缺损疗效比较的Meta分析. 中国循证心血管医学杂志, 2019, 11(12): 1426-1430.
6. 高开柱, 李小波, 李庆国, 等. 四种方法治疗继发孔房间隔缺损的比较. 心肺血管病杂志, 2019, 38(4): 399-402, 408.
7. Karatasakis A, Brilakis HS, Danek BA, et al. Radiation-associated lens changes in the cardiac catheterization laboratory: Results from the IC-CATARACT (CATaracts Attributed to RAdiation in the CaTh lab) study. Catheter Cardiovasc Interv, 2018, 91(4): 647-654.
8. Hill KD, Frush DP, Han BK, et al. Radiation safety in children with congenital and acquired heart disease: A scientific position statement on multimodality dose optimization From the Image Gently Alliance. JACC Cardiovasc Imaging, 2017, 10(7): 797-818.
9. Yang Y, Zhang W, Wu Q, et al. Transcatheter closure of atrial septal defects without fluoroscopy: A well-established procedure for alternative use in children. EuroIntervention, 2016, 12(5): e652-e657.
10. Schubert S, Kainz S, Peters B, et al. Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients. Clin Res Cardiol, 2012, 101(9): 691-700.
11. Li GS, Li HD, Yang J, et al. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims. PLoS One, 2012, 7(12): e51117.
12. Erdem A, Sarıtas T, Zeybek C, et al. Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults. Int J Cardiovasc Imaging, 2013, 29(1): 53-61.
13. 朱达, 周莹, 刘斌. 经食管实时三维超声心动图在心脏外科手术中的应用进展. 中国胸心血管外科临床杂志, 2011, 18(4): 354-358.
14. Ma LL, Wang YY, Yang ZH, et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better? Mil Med Res, 2020, 7(1): 7.
15. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
16. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17. 王钰, 骆志玲, 潘家华, 等. 非X线下经胸壁超声全程引导经导管房间隔缺损封堵术的应用研究. 中华超声影像学杂志, 2009, 18(1): 31-33.
18. 欧阳文斌, 潘湘斌, 逄坤静, 等. 单纯食管超声引导经皮封堵治疗房间隔缺损. 中华实用儿科临床杂志, 2014, 29(18): 1425-1427.
19. 韦宝敏, 黄艳新, 李志乐, 等. 经胸超声心动图引导下行房间隔缺损封堵术治疗先天性房间隔缺损的临床研究. 现代生物医学进展, 2016, 16(19): 3724-3727.
20. 韩宇. 食管超声心动图引导技术在房、室间隔缺损介入封堵术中的应用研究. 郑州大学, 2016.
21. 陈孔敏. 完全超声心动图引导下经皮房间隔缺损封堵术的疗效分析. 福建医科大学, 2017.
22. 董向阳, 李文静, 陈忠建. 彩色多普勒超声在房间隔缺损介入封堵术中的应用价值. 保健医学研究与实践, 2017, 14(4): 49-51, 55.
23. 赵烨, 陈洪余, 林荣, 等. 经胸超声心动图全程引导下房间隔缺损封堵术的临床应用. 包头医学院学报, 2017, 33(2): 13-14.
24. Xu W, Li J, Ye J, et al. Transesophageal echocardiography and fluoroscopy for percutaneous closure of atrial septal defects: A comparative study. Medicine (Baltimore), 2018, 97(43): e12891.
25. 徐玮泽, 叶菁菁, 李建华, 等. 单纯食管超声心动图引导经皮房间隔缺损封堵术治疗房间隔缺损患儿的疗效. 浙江大学学报(医学版), 2018, 47(3): 244-249.
26. 杨明川. 单纯经胸超声引导经皮介入治疗房间隔缺损的临床研究. 石河子大学, 2018.
27. Ackermann S, Quandt D, Hagenbuch N, et al. Transcatheter atrial septal defect closure in children with and without fluoroscopy: A Comparison. J Interv Cardiol, 2019, 2019: 6598637.
28. 蒙茂龙, 刘志红, 王志伟, 等. 超声引导经颈静脉封堵治疗房间隔缺损的疗效及安全性分析. 现代医学与健康研究电子杂志, 2019, 3(16): 28-29.
29. 解晓薇, 步建丽, 郄占军. 经食道超声在经股静脉途径房间隔缺损介入封堵术中的应用价值. 宁夏医科大学学报, 2019, 41(2): 189-192.
30. 赵丽丽. 单纯经胸超声引导经皮房间隔缺损封堵术安全性和可行性的研究. 内蒙古医科大学, 2019.
31. 邓润迪, 张凤文, 谢涌泉, 等. 超声引导经皮房间隔缺损封堵术治疗门诊患者的可行性研究. 中国胸心血管外科临床杂志, 2020, 27(1): 10-13.
32. 郭怡萍. TEE引导经皮封堵与X线下封堵及外科小切口治疗房间隔缺损的对比研究. 新乡医学院, 2020.
33. Li P, Fang F, Qiu X, et al. Personalized three-dimensional printing and echoguided procedure facilitate single device closure for multiple atrial septal defects. J Interv Cardiol, 2020, 2020: 1751025.
34. 张凌波, 郭寰, 李育东, 等. 继发孔房间隔缺损经胸实时三维超声心动图引导封堵术可行性研究. 中国心血管病研究, 2020, 18(7): 632-634.
35. 王锋剑, 王仲朝, 张俊奇, 等. 经TEE引导与DSA引导下房间隔缺损介入封堵术的比较研究. 中西医结合心脑血管病杂志, 2020, 18(13): 2186-2188.
36. 陈银海. RT-3D-TTE与X线引导下经皮封堵术治疗继发孔房间隔缺损的临床效果对比. 医学理论与实践, 2021, 34(11): 1845-1846.
37. O'Byrne ML, Glatz AC, Sunderji S, et al. Prevalence of deficient retro-aortic rim and its effects on outcomes in device closure of atrial septal defects. Pediatr Cardiol, 2014, 35(7): 1181-1190.
38. 移康, 许建国, 尤涛, 等. 放射线引导经皮封堵与超声引导经胸封堵治疗房间隔缺损疗效比较的Meta分析. 心肺血管病杂志, 2019, 38(5): 573-580.
39. 肖家旺, 朱鲜阳. 中国先天性心脏病介入治疗发展历程. 协和医学杂志, 2021, 12(3): 303-308.
40. 温朝阳, 李越, 王廉一, 等. 超声引导Amplatzer封堵器关闭房间隔缺损的初步体会. 中华超声影像学杂志, 1999, 8(5): 26-28.
41. García-Fuertes D, Mesa-Rubio D, Ruiz-Ortiz M, et al. Monitoring complex secundum atrial septal defects percutaneous closure with real time three-dimensional echocardiography. Echocardiography, 2012, 29(6): 729-734.
42. Pan XB, Ou-Yang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol, 2015, 28(4): 390-395.
43. Bartel T, Müller S. Contemporary echocardiographic guiding tools for device closure of interatrial communications. Cardiovasc Diagn Ther, 2013, 3(1): 38-46.
44. Price MJ, Smith MR, Rubenson DS. Utility of on-line three-dimensional transesophageal echocardiography during percutaneous atrial septal defect closure. Catheter Cardiovasc Interv, 2010, 75(4): 570-577.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of echocardiography-guided alone versus fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis

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