Transcatheter Versus Surgical Closure of Atrial Septal Defect in Children and Adults: A Systematic Review and Meta-Analysis of Observational Studies.

BACKGROUND

Atrial septal defect closure can be performed surgically or via transcatheter intervention, yet comparative outcomes remain inconsistent between children and adults. This review synthesizes observational evidence to evaluate procedural success, complications, and periprocedural characteristics across both populations.

METHODS

A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was conducted, including 36 observational studies published through 2024. Study quality was assessed using the Newcastle-Ottawa Scale. Random effects models were applied, with subgroup analyses by age and procedure type. Publication bias was examined using funnel plots and Egger's test.

RESULTS

The pooled procedural success rate was 95% (95% CI: 92%-97%; I² = 90.2%). Among children, raw procedural success was 87% (1445/1656) for transcatheter closure and 99% (505/510) with surgery. In adults, transcatheter closure achieved 97% (95% CI: 90%-99%), whereas surgery reached 98% (95% CI: 70%-100%). Transcatheter closure resulted in shorter hospitalization (mean difference: -3.86 days, 95% CI: -6.03 to -1.69; P = .0004) and fewer major complications (risk ratio: 0.58, 95% CI: 0.39-0.86; P = .006). Sensitivity analysis restricted to high-quality studies (n = 12) remained consistent. Egger's regression did not indicate significant publication bias (P = .069).

CONCLUSION

Both approaches provide high closure success, yet transcatheter intervention offers lower complication rates and faster recovery, particularly in anatomically suitable patients. These findings support individualized treatment selection based on age, anatomy, and institutional experience.