Transthoracic device closure lowers risk of postoperative arrhythmia
Transthoracic device closure (TTDC) seems to reduce the postoperative risk of arrhythmia and is not associated with the risk of other complications, according to a new meta-analysis.
Pooled data from 23 studies (n=4,626) that focused on success rate showed that TTDC resulted in significantly lower rate compared to conventional open-heart surgery (COHS; relative risk [RR], 0.97; 95 percent CI, 0.96 to 0.99; p<0.0001) and case-controls (odds ratio [OR], 0.23; 0.12 to 0.43; p<0.00001).
In terms of intraoperative complications, the case-controls studies showed that TTDC and COHS had comparable rates of intraoperative arrhythmias (OR, 1.18; 0.52 to 2.67; p=0.68). In contrast, cohort studies showed that TTDC significantly decreased the risk of the complication compared with COHS (RR, 0.48; 0.25 to 0.92; p=0.03).
Pooled data from cohort studies also revealed no significant difference in the rates of intraoperative aortic valve insufficiency (RR, 0.89; 0.08 to 9.61; p=0.92) and of residual shunts (RR, 3.39; 0.39 to 4.83; p=0.24) between COHS and TTDC. In case-controlled studies, TTDC had a higher risk of intraoperative residual shunts (OR, 6.98; 1.17 to 41.61 to p=0.03).
Pooled data from four randomized controlled trials found that the risk of postoperative complications was significantly lower for TTDC than COHS (RR, 0.20; 0.13 to 0.32; p<0.00001). The same trend was observed when data from five cohort studies were pooled (RR, 0.50; 0.35 to 0.70; p<0.0001).
In comparison, case-control studies found no significant difference in the risk of postoperative complications (OR, 0.87; 0.42 to 1.79; p=0.71).