A meta-analysis of perventricular device closure of perimembranous ventricular septal defect

BACKGROUND: To investigate the safety and efficacy of perventricular device closure of perimembranous VSD (pmVSD). METHODS: PubMed and Scopus were searched for studies in English focusing on perventricular device closure of pmVSD published up to the end of March 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. RESULTS: A total of 15 publications comprising 1368 patients with pmVSD were included. The median follow-up duration was 2 months to 5 years, with a mean patient age ranging from 2 months to 56 years. The pooled success rate was 0.95 (I(2) = 86.2%, P = 0.000). The pooled rate of postoperative residual shunting was 0.02 (95% CI: 0.01–0.03, I(2) = 87.3%, P < 0.001). The pooled rate of residual shunting in the follow-up period was 0.001 (95% CI:-0.001–0.002, I(2) = 30.5%, P = 0.126). The pooled estimated rate of severe complications was 0.074 (95% CI: 0.046–0.102, I(2) = 30.5%, P = 0.126). The pooled incidence of complete atrioventricular block (cAVB) was 0.002 (95% CI: 0.000–0.005, I(2) = 0.0%, P = 0.577). CONCLUSIONS: Perventricular device closure may be an alternative to conventional surgical repair in selected patients with pmVSD. The success rate was stable regarding the publication year and sample size and suggested both the short learning curve of this technology and its potential for wide application. The incidence of severe arrhythmia, especially cAVB, was low. These good results may be limited by the number of enrolled patients, and a more detailed and larger sample is required for further analysis.