Transcatheter closure of atrial septal defect in elderly: a systematic review and meta-analysis
Bibliographic record
Abstract
Despite the establishment of transcatheter closure as the treatment of choice in adults with secundum atrial septal defects (ASDs), the effectiveness of this approach in elderly is disputed. This systematic review and meta-analysis involved studies exploring the impact of transcatheter ASD closure in patients ≥60 years old. We systematically searched four major databases, including PubMed, CENTRAL, Scopus and Web of Science. ClinicalTrials.gov, references of the selected articles as well as sources of grey literature were also hand-searched. Primary outcomes were the right ventricular end-diastolic diameter (RVEDD) and the New York Heart Association (NYHA) functional class, whereas secondary outcomes included the left ventricular end-diastolic diameter (LVEDD), systolic pulmonary arterial pressure (sPAP), plasma Brain Natriuretic Peptide (BNP) levels, tricuspid valve regurgitation (TR), atrial arrhythmias, and mortality. The Newcastle–Ottawa scale was used to assess the studies’ quality. Eighteen observational cohort studies with 1184 patients were included in the meta-analysis. RVEDD was significantly reduced after ASD closure (standardized mean difference [SMD] -0.9, 95% confidence intervals [CI] -1.2; -0.7). Elderly patients had 9.5 times higher odds of being asymptomatic after versus before ASD closure (95% CI 5.06; 17.79). Furthermore, transcatheter ASD closure significantly improved LVEDD (SMD 0.8, 95% CI 0.7; 1.0), sPAP (mean difference [MD] 10.8, 95% CI -14.6; -7), TR severity (odds ratio [OR] 0.39, 95% CI 0.25; 0.60) and BNP levels (MD 68.3, 95% CI -114.4; -22.1). There was no effect of ASD closure on atrial arrhythmias (OR 0.88, 95% CI 0.42; 1.88), while overall mortality after ASD closure yielded a pooled proportion of 0.10 (95% CI 0.06; 0.16). Transcatheter ASD closure improved functional capacity, right and left ventricular dimensions, sPAP, TR, BNP levels without increasing the likelihood of atrial arrhythmias in elderly. Future larger studies are warranted to confirm our findings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.007 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".