AUTHOR=Song Yi , Xing Hang , Koch Peter David , Li Xiaofei , Zhang Yan 

TITLE=The feasibility and safety of combining atrial septal defect/patent foramen ovale and left atrial appendage closure: A systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1080257

DOI=10.3389/fcvm.2022.1080257

ISSN=2297-055X

ABSTRACT=Atrial Septal Defect/Patent Foramen Ovale (ASD/PFO) occlusion is performed to prevent paradoxical embolism and reduce the risk of recurrent ischemic stroke. Left atrial appendage (LAA) closure is used as an alternative to medical therapy of nonvalvular atrial fibrillation for prevention of stroke. Multiple studies have examined performing LAA and ASD/PFO occlusion. However, the feasibility and safety of combined occlusion of the left atrial appendage and ASD/PFO is not clear, furthermore, these studies are limited by their small sample sizes and retrospective analysis. In this study, we aimed to systematically review and meta-analyze the feasibility and safety of combining left atrial appendage and ASD/PFO closure.

PubMed, Web of Science, CNKI, Cochrane Library, Embase, WanFang database were searched up to April 2022 to identify peer-reviewed human studies on assessing the feasibility, safety and efficacy of combining left atrial appendage and ASD/PFO closure. The primary outcome was calculated: procedural feasibility outcome and procedural safety outcome. 

A total of 10 articles, including 340 patients from multiple countries, were included in the analysis. The principal findings of our study are: compared with single LAA closure, i) combining PFO/ASD occlusion and LAA closure had similar procedural success proportion (98.43%, 95% CI: 96.67 to 100.00%), ii) similar safety event incidences developed (1.67%, 95% CI: 0.24 to 3.92%), subgroup analyzed safety event incidences in death was 0.00 (95% CI: 0.00 to 0.33%), cardiac tamponade was 0.87% (95% CI: 0.00 to 2.77%), device embolization was 0.00 (95% CI: 0.00 to 0.60%), major bleeding was 0.00 (95% CI: 0.00 to 0.33%), stroke was 0.00 (95% CI: 0.00 to 0.02%).

Although this systematic review and meta-analysis demonstrate the technical feasibility and safety of combining closure of PFO/ASD and LAA, the further studies of sufficient sample size, long-term follow-up, and rigor endpoint criteria are yet needed to fully evaluate this combination procedure for its role in clinical outcomes.