Percutaneous Zero-Fluoroscopy Atrial Septal Defect Closure Versus Fluoroscopy-Guided Method: A Systematic Review and Meta-analysis

Percutaneous atrial septal defects (ASD) closure with fluoroscopy guidance is the standard procedure. However, fluoroscopy poses stochastic and deterministic risks for small infants and children. Zero fluoroscopy ASD closure is an alternative, yet its feasibility and safety compared to fluoroscopy remain unclear. Therefore, this study compares outcomes using standardized fluoroscopy and zero fluoroscopy methods for transcatheter ASD closure. Four databases (PubMed, ProQuest, Google Scholar, Wiley) were used to search literature published before July 2023. The main results were the success rate and the complications. Outcomes were processed using the DerSimonian-Laird random-effects model of proportional meta-analysis to determine the overall proportion. A total of 68 cohort studies (8,989 patients) were included in this meta-analysis. Overall, percutaneous ASD closure was successfully performed in 97% of patients (95%CI: 96-98%) based on 59 studies (8,989 patients), of which fluoroscopy accounted for 97% (95%CI: 96- 98%) based on 51 studies (7,760 patients) and non-fluoroscopy for 98% (95%CI: 96-100%)] based on 8 studies (1,229 patients). Device embolization, AV block, and other arrhythmias did not differ significantly between the two groups. However, the percentage difference in residual leaks between the two groups was quite vast, with 5% in the non-fluoroscopy group and 12% in the fluoroscopy group. Percutaneous ASD closure with zero fluoroscopy is safe and effective, as evidenced by the high success rate, and is non-inferior to the standardized fluoroscopy method.