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Meta-Analysis
. 2023 Nov 10;109(23):1741-1750.
doi: 10.1136/heartjnl-2023-322529.

Transcatheter closure of atrial septal defect in the elderly: a systematic review and meta-analysis

Amalia Baroutidou  1 , Alexandra Arvanitaki  1   2 , Ioannis T Farmakis  1   3 , Vasiliki Patsiou  1 , Andreas Giannopoulos  4 , Georgios Efthimiadis  1 , Antonios Ziakas  1 , George Giannakoulas  5
Affiliations
Meta-Analysis

Transcatheter closure of atrial septal defect in the elderly: a systematic review and meta-analysis

Amalia Baroutidou et al. Heart. .

Abstract

Objective: Despite the establishment of transcatheter closure as the treatment of choice in adults with secundum atrial septal defects (ASDs), the effectiveness of this approach in the elderly is disputed. This systematic review and meta-analysis aims to explore the impact of transcatheter ASD closure in patients ≥60 years old.

Methods: We systematically searched four major electronic databases (PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus and Web of Science), ClinicalTrials.gov, article references and grey literature. Primary outcomes were the right ventricular end-diastolic diameter (RVEDD) and the New York Heart Association functional class change, whereas secondary outcomes included systolic pulmonary arterial pressure (sPAP), left ventricular end-diastolic diameter (LVEDD), brain natriuretic peptide (BNP), tricuspid valve regurgitation (TR) change, as well as the rate of atrial arrhythmias and all-cause mortality.

Results: In total, 18 single-arm cohorts comprising 1184 patients were included. RVEDD was reduced after ASD closure (standardised mean difference (SMD) -0.9, 95% CI -1.2 to -0.7). Elderly patients had 9.5 times higher odds of being asymptomatic after ASD closure (95% CI 5.06 to 17.79). Furthermore, ASD closure improved sPAP (mean difference (MD) -10.8, 95% CI -14.6 to -7), LVEDD (SMD 0.8, 95% CI 0.7 to 1.0), TR severity (OR 0.39, 95% CI 0.25 to 0.60) and BNP (MD -68.3, 95% CI -114.4 to -22.1). There was a neutral effect of ASD closure on atrial arrhythmias.

Conclusions: Transcatheter ASD closure is beneficial for the elderly population since it improves functional capacity, biventricular dimensions, pulmonary pressures, TR severity and BNP. However, the incidence of atrial arrhythmias did not change significantly after the intervention.

Prospero registration number: CRD42022378574.

Keywords: congenital abnormalities; heart septal defects, atrial.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flowchart. CENTRAL, Cochrane Central Register of Controlled Trials; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plot of the SMD in RVEDD after transcatheter ASD closure. ASD, atrial septal defect; RVEDD, right ventricular end-diastolic diameter; SMD, standardised mean difference.
Figure 3
Figure 3
Forest plot of NYHA I functional class after versus before ASD closure. ASD, atrial septal defect; NYHA, New York Heart Association.
Figure 4
Figure 4
(A) Forest plot of the mean difference in sPAP after transcatheter ASD closure. (B) Forest plot of TR after versus before transcatheter ASD closure. ASD, atrial septal defect; MD, mean difference; sPAP, systolic pulmonary arterial pressure; TR, tricuspid valve regurgitation.
Figure 5
Figure 5
(A) Forest plot of the SMD in LVEDD after transcatheter ASD closure. (B) Forest plot of the mean difference in plasma BNP levels after transcatheter ASD closure. ASD, atrial septal defect; BNP, brain natriuretic peptide; LVEDD, left ventricular end-diastolic diameter; MD, mean difference; SMD, standardised mean difference.
Figure 6
Figure 6
(A) Forest plot of atrial arrhythmias after versus before transcatheter ASD closure. (B) Forest plot of all-cause mortality after transcatheter ASD closure. ASD, atrial septal defect.
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