Abstract

Background

Percutaneous mitral valve repair (PMVR) requires a puncture of the atrial septum, resulting in iatrogenic atrial septal defect (iASD), which usually causes a transient left-to-right shunt. However, the influencing risk factors for iASD persistence and functional consequences are not fully understood. This meta-analysis aimed to summarise available data on the persistence of iASD following PMVR.

Methods

The authors conducted a literature search in PubMed/MEDLINE and EMBASE databases to identify studies investigating iASD persistence in PMVR patients.

Results

Six observational studies (n = 361) met inclusion criteria for the final analysis. Prevalence of persistent iASD was documented with 28% after 12 months follow-up. iASD size increased over time with a diameter of 5.3 ± 0.76 mm after one month and 6.5 ± 0.21 mm after 12 months. Possible predictors of iASD persistence after PMVR appeared to be pre-existing AF (RR 1.24; p = .03), residual mitral regurgitation > II° (RR 2.06; p = .03) and prolonged fluoroscopic time (RR 8.27; p = .01). Patients with iASD persistence had a higher risk for development of right heart overload regarding the increased area of the right atrium (MD 5.24; p = .004) and enlarged diameter of the right ventricle (MD 3.33; p < .0001). Rehospitalization was more frequently reported in iASD patients (RR 9.52; p = .004).

Conclusions

This meta-analysis proved iASD persistence in 28% of PMVR after 12 months follow-up with a higher risk for right heart volume overload and more frequent rehospitalization compared to patients without iASD persistence. Since percutaneous catheter-based treatments with transseptal approaches are rising, further evidence about the hemodynamic impact of persistent iASD is warranted.

中文翻译：

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经皮二尖瓣修复术后医源性房间隔缺损持续存在：荟萃分析

摘要

背景

经皮二尖瓣修复术 (PMVR) 需要穿刺房间隔，导致医源性房间隔缺损 (iASD)，这通常会导致短暂的左向右分流。然而，影响 iASD 持续性和功能后果的风险因素尚不完全清楚。该荟萃分析旨在总结有关 PMVR 后 iASD 持续性的可用数据。

方法

作者在 PubMed/MEDLINE 和 EMBASE 数据库中进行了文献检索，以确定调查 PMVR 患者 iASD 持续性的研究。

结果

六项观察性研究 ( n  = 361) 符合最终分析的纳入标准。随访 12 个月后，持续性 iASD 的患病率为 28%。iASD 大小随时间增加，1 个月后直径为 5.3 ± 0.76 mm，12 个月后直径为 6.5 ± 0.21 mm。PMVR 后 iASD 持续存在的可能预测因素似乎是预先存在的 AF (RR 1.24; p  = .03)、残余二尖瓣关闭不全 > II° (RR 2.06; p  = .03) 和延长的透视时间 (RR 8.27; p  = . 01)。由于右心房面积增加（MD 5.24； p  = .004）和右心室直径扩大（MD 3.33；p ），持续存在 iASD 的患者发生右心超负荷的风险更高 < .0001)。iASD 患者的再住院率更高（RR 9.52；p  = .004）。

结论

这项荟萃分析证明，与没有 iASD 持续性的患者相比，在 12 个月的随访后，28% 的 PMVR 持续存在 iASD，右心容量超负荷的风险更高，再住院的频率更高。由于采用经间隔入路的基于经皮导管的治疗正在增加，因此需要进一步证明持续性 iASD 对血流动力学的影响。