Long term outcomes among adults post transcatheter atrial septal defect closure: Systematic review and meta-analysis

Background: Transcatheter Closure (TC) has become the main stay therapy for many secundum atrial septal defects (ASD) based on short and intermediate term outcome data. Long-term safety and efficacy of this approach among adult patients however, is not well established. Methods and results: A comprehensive search of major electronic databases for studies reporting the long-term (>= 5 year) outcomes post TC among adults yielded 114 studies, 9 of which had met the inclusion criteria. This included 1015 patients with a mean age of 45 years +/- 5.5 years, two third were female with amean follow up duration 6.4 years +/- 2.7 years. The weighted proportions of long-term mortality and stroke with 95% confidence intervals (CI) were 2.4% (95% CI 0.9%-6.1%) and 2.1% (95% CI 0.7%-5.7%) respectively. Atrial arrhythmia occurred in 6.5% (95% CI 3.5%-11.7%) and atrial fibrillation in 4.9% (95% CI 1.9%-11.7%). ASD related re-interventions were encountered in 2.3% (95% CI 1.0%-5.4%) and residual shunt in 4.2% (95% CI 1.3%-12.4%), with 1 case of suspected device erosion 0.9% (95% CI 0.4-2.2%). Frame fractures and late migrations were observed at 4.2% (95% CI 1.5%-11.5%) and 1.2% (95% CI 0.3%-4%) respectively. No cases of occluder endocarditis or thrombosis were reported. In conclusion: This is the first study that systematically analyzes the long-term outcomes after TC providing important estimates for various clinical and occluder related outcomes. The analysis suggests preserved long-term safety post TC; however, this is limited due to the variable quality of available evidence and requires further assessment by larger studies with more comprehensive follow-up data. (c) 2018 Published by Elsevier B.V.