Table 5.
Comparison of advantages and disadvantages among different treatment strategies
|
Treatment method
|
Indications
|
Success rate (%)
|
Complications incidence (%)
|
Cost-effectiveness
|
Ref.
|
| Percutaneous interventional closure procedure (TCC) | The condition is stable, the perforation diameter is ≤ 20 mm, and the location is away from the valve structures | 73.8 (3-year survival rate) | 32 (Residual shunt, mechanical hemolysis) | Moderate (requiring high-precision imaging equipment and consumables) | [20,82,193-195] |
| Surgical repair (combining CABG) | Perforation diameter > 20mm, multivessel disease, combined with ventricular aneurysm or valvular injury | 70 (3-year survival rate) | 40-52 (Postoperative infection, cardiogenic shock) | Low (The surgical costs are high, requiring long-term monitoring and care) | [98,114,165,169] |
| Medical conservative treatment (medication + IABP/ECMO) | Hemodynamically extremely unstable, unable to tolerate surgery or interventional therapy | 38.5 (30-day survival rate) | 50-60 (multiple organ failure, hemorrhage) | Low short-term costs, but high long-term expenses (requires repeated hospitalizations) | [25,165,196] |
| Delayed intervention closure (occurring > 3 weeks after VSR) | Myocardial edema subsides, hemodynamics stabilize, and perforated tissue becomes fibrotic | 96.3 (30-day survival rate) | 10-15 (Residual shunt, arrhythmia) | High (reduces the risk of secondary surgery) | [58,82,193,197] |
| Early intervention and occlusion (VSR occurrence ≤ 3 weeks) | Emergency rescue, unable to wait for delayed surgery | 62.5 (30-day survival rate) | 45-50 (Perforation enlargement, occluder displacement) | Moderate (urgent resource support required) | [193,198,199] |
| VA-ECMO combined with IABP support | CS, hemodynamic collapse | 40 (Survival rate improvement) | 25-30 (Lower limb ischemia, hemorrhage) | Low (equipment and monitoring costs are high) | [169,200,201] |
| Pharmacological treatment alone (diuretics + vasodilators) | Hospice care or transitional treatment | 14.3 (30-day survival rate) | 60-70 (Deterioration of renal function, electrolyte imbalance) | Minimum (drug cost only) | [165,202,203] |
| Interventional occlusion combined with PCI procedure | Single-vessel disease, late-onset VSR after PCI | 91.4 (Surgical success rate) | 20-25 (Stent thrombosis, residual shunt) | Moderate (requires phased implementation) | [58,194,195] |
| Surgical procedure combined with CABG | Multivessel disease requiring revascularization, combined with complex anatomical structures | 80 (Long-term survival rate) | 35-40 (Postoperative infection, stroke) | Low (surgical and rehabilitation costs compounded) | [93,169,204] |
| Staged interventional therapy (occlusion first followed by PCI) | Hemodynamically stable but requires revascularization | 85 (1-year survival rate) | 15-20 (Secondary operational risk) | Moderate (phased fee accumulation) | [195,203,205] |
| Palliative care (anti-heart failure medications) | Advanced age, severe comorbidities, limited life expectancy | - | - | Minimum (only basic medication costs) | [105,119,165] |
| IABP standalone support | Mild cardiogenic shock, transition to definitive treatment | 20 (Survival rate improvement) | 15-20 (Lower limb ischemia, catheter infection) | Moderate (equipment rental and monitoring costs) | [118,169,206] |
| Emergency surgical procedure (≤ 7 days) | Hemodynamically unstable, unable to wait for myocardial repair | 57 (30-day survival rate) | 50-60 (Postoperative heart failure, infection) | Low (emergency surgery costs and high risk) | [83,111,165] |
| Delayed surgical procedure (> 4 weeks) | Myocardial tissue stabilization, hemodynamic improvement | 93.5 (30-day survival rate) | 10-15 (Postoperative adhesions, arrhythmia) | High (surgical success rate improvement) | [112,173,193] |
| Hybrid surgery (interventional + surgical) | Complex perforations (multiple holes or serpentine tracts), residual shunts requiring secondary intervention | 75 (Overall success rate) | 30-35 (Multi-stage complication risks) | Low (high cost of multidisciplinary collaboration) | [10,93] |
| Anticoagulation therapy (heparin/warfarin) | Hypercoagulable state, embolism prevention | - | 20-25 (Bleeding, thrombocytopenia) | Low (primarily drug costs) | [82,169,202,207] |
| Anti-inflammatory therapy (glucocorticoids) | Systemic inflammatory response, significant elevation of CRP | 30 (Prognosis improvement rate) | 10-15 (Risk of infection increases) | Moderate (requires monitoring of infection indicators) | [106,165,169,208] |
| Transcatheter thrombolytic therapy | No PCI conditions, early reperfusion requirements | 50 (Recanalization rate) | 30-40 (Bleeding, allergic reactions) | Low (medication costs are low, but complication treatment expenses are high) | [58,169,209] |
| Pericardiocentesis drainage | Massive pericardial effusion leading to cardiac tamponade | 90 (Symptom remission rate) | 5-10 (Puncture injury, infection) | Moderate (requires imaging guidance and aseptic operation) | [116,210] |
| MELD-XI Score-Guided Therapy | Risk stratification in patients with hepatic and renal dysfunction | - | - | High (optimizing resource allocation and reducing ineffective treatment) | [58,82,83] |
TCC: Transcatheter Closure; CABG: Coronary artery bypass graft; IABP: Intra-aortic balloon pump; ECMO: Extraciroireal membrane oxygenation; CS: Cardiogenic shock; PCI: Percutaneous coronary intervention; VSR: Ventricular septal rupture.