Percutaneous Zero-fluoroscopy Atrial Septal Defect Closure Versus Fluoroscopy-guided Method: A Systematic Review and...

Area of Science:

• Cardiology
• Medical Devices
• Interventional Procedures

Background:

• Percutaneous closure of atrial septal defects (ASD) using fluoroscopy is standard but poses risks to pediatric patients.
• Zero fluoroscopy transcatheter closure is an emerging alternative, necessitating a comparison of its safety and efficacy.

Purpose of the Study:

• To compare the outcomes of transcatheter ASD closure using standardized fluoroscopy versus a zero fluoroscopy approach.
• To evaluate the feasibility and safety of the zero fluoroscopy method in pediatric patients.

Main Methods:

• A systematic literature search was conducted across four databases (PubMed, ProQuest, Google Scholar, Wiley) for studies published before July 2023.
• Meta-analysis using the DerSimonian-Laird random-effects model was employed to determine success rates and complication proportions.
• Included studies focused on percutaneous closure of ASD, comparing fluoroscopy-guided and zero fluoroscopy techniques.

Main Results:

• The meta-analysis included 68 cohort studies with 8,989 patients.
• Overall success rates for percutaneous ASD closure were high (97%), with similar rates for fluoroscopy (97%) and zero fluoroscopy (98%) groups.
• While major complications like device embolization and arrhythmias did not differ, residual leaks were significantly lower in the zero fluoroscopy group (5% vs. 12%).

Conclusions:

• Percutaneous ASD closure without fluoroscopy is a safe and effective alternative to the standard fluoroscopy-guided method.
• The zero fluoroscopy approach demonstrates non-inferiority in terms of success rates and may offer advantages in reducing residual leaks.