Right ventricular outlet tract reconstruction for tetralogy of Fallot: systematic review and network meta-analysis

被引：0

作者：

Yamaguchi, Akira ^{[1
]}

Shimoda, Tomonari ^{[2
]}

Kinami, Hiroo ^{[3
]}

Yasuhara, Jun ^{[4
]}

Takagi, Hisato ^{[5
]}

Fukuhara, Shinichi ^{[6
]}

Kuno, Toshiki ^{[7
,8
,9
]}

机构：

[1] Univ Tsukuba, Div Cardiovasc Surg, Tsukuba, Ibaraki, Japan

[2] Ibaraki Prefectural Univ Hlth Sci, Dept Med, Ami, Ibaraki, Japan

[3] Stanford Univ, Lucile Packard Childrens Hosp, Div Pediat Cardiac Surg, Sch Med, Palo Alto, CA USA

[4] Royal Childrens Hosp, Dept Cardiol, Melbourne, Vic, Australia

[5] Shizuoka Med Ctr, Dept Cardiovasc Surg, Shizuoka, Japan

[6] Univ Michigan, Dept Cardiothorac Surg, Ann Arbor, MI USA

[7] Albert Einstein Coll Med, Montefiore Med Ctr, Div Cardiol, Bronx, NY USA

[8] Albert Einstein Coll Med, Jacobi Med Ctr, Div Cardiol, Bronx, NY USA

[9] Harvard Med Sch, Massachusetts Gen Hosp, Cardiol Div, 55 Fruit St,GRB 800, Boston, MA 02114 USA

来源：

INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY | 2024年 / 39卷 / 06期

关键词：

Tetralogy of Fallot; Network meta-analysis; Right ventricular outlet tract reconstruction; PULMONARY VALVE FUNCTION; MONOCUSP VALVE; TRANSANNULAR PATCH; OUTFLOW TRACT; SPARING TECHNIQUES; REPAIR; IMPLANTATION; AUGMENTATION; STRATEGY; CHILDREN;

D O I：

10.1093/icvts/ivae180

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES Concerns persist regarding pulmonary regurgitation after transannular patch repair (TAP) for tetralogy of Fallot. Despite the introduction of various architectural preservation techniques, the optimal strategy remains controversial. Our goal was to compare different right ventricular outlet tract reconstruction techniques.METHODS PubMed, EMBASE and Cochrane Central were searched through March 2024 to identify comparative studies on right ventricular outlet tract reconstruction techniques (PROSPERO ID: CRD42024519404). The primary outcome was mid-term pulmonary regurgitation, with secondary outcomes including postoperative mortality, postoperative pulmonary regurgitation, length of intensive care unit stays, postoperative right ventricular outlet tract pressure gradient and mid-term mortality. We performed a network meta-analysis to compare outcomes among TAP, valve-repairing (VR), TAP with neo-valve creation (TAPN) and valve-sparing (VS).RESULTS Two randomized controlled studies and 32 observational studies were identified with 8890 patients. TAP carried a higher risk of mid-term pulmonary regurgitation compared to TAPN [hazard ratio, 0.53; 95% confidence interval (CI) (0.33; 0.85)] and VS [hazard ratio, 0.27; 95% CI (0.19; 0.39)], with no significant difference compared to VR. VS was also associated with reduced postoperative mortality compared to TAP [risk ratio, 0.31; 95% CI (0.18; 0.56)], in addition to reduced ventilation time. TAP also carried an increased risk of postoperative pulmonary regurgitation compared to the other groups. The groups were comparable in terms of length of intensive care unit stay, right ventricular outlet tract pressure gradient and mid-term mortality.CONCLUSIONS VR was associated with a reduced risk of postoperative pulmonary regurgitation, whereas TAPN was associated with reduced risks of both postoperative and mid-term pulmonary regurgitation. Since Kirklin and colleagues introduced the transannular patch repair (TAP) method, the strategy for right ventricular outlet tract reconstruction (RVOTR) in tetralogy of Fallot (TOF) has been refined over the past decades [1].

引用

页数：10

共 66 条

[1] Duct stenting versus modified Blalock -Taussig shunt in neonates and infants with duct-dependent pulmonary blood flow: A systematic review and meta-analysis [J].