Pulmonary Valve Replacement After Operative Repair of Tetralogy of Fallot
Pulmonary Valve Replacement After Operative Repair of Tetralogy of Fallot
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DOI：
10.1016/j.jacc.2013.04.107
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发表时间：
2013-12-10
影响因子：
24
通讯作者：
Lima, Ricardo de Carvalho
中科院分区：
文献类型：
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作者：
Ferraz Cavalcanti, Paulo Ernando;Barros Oliveira Sa, Michel Pompeu;Lima, Ricardo de Carvalho
由于肺动脉瓣置换术（PVR）在法洛四联症修复后发生肺功能不全的患者中的真实的获益尚不清楚，因此有必要分析世界各地发表的证据。我们对截至2012年12月报告了PVR对发生肺功能不全的法洛四联症修复患者的影响数据的研究进行了系统综述。选择代表受益的变量为右心室（RV）和左心室测量值、QRS时限和功能分级。主要的汇总测量是平均值的差异，95%置信区间和p值（当p < 0.05时认为具有统计学意义）。使用加权DerSimonian-Laird随机效应模型将研究间的平均值差异合并。用软件Comprehensive Meta-Analysis（第2版，Biostat，Inc.，恩格尔伍德，新泽西）。48项研究（涉及3，118例患者）符合合格标准。汇总的30天死亡率为0.87%（47项研究; 27/3100例患者）;汇总的5年死亡率为2.2%（24项研究; 49/2231例患者）;汇总的5年再PVR为4.9%（15项研究; 88/1798例患者）。该荟萃分析的结果表明，PVR后：1）RV的容积和功能得到改善; 2）左心室的功能得到改善; 3）QRS时限缩短; 4）症状改善; 5）术前RV几何形状调节PVR的效果; 6）研究之间的效果存在重要异质性，几乎没有发表偏倚。总之，PVR似乎是一个积极的方法，在分析的情况。(C)2013年美国心脏病学会基金会
Because the real benefit of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot who develop pulmonary insufficiency remains unclear, it is necessary to analyze the evidence published around the world. We performed a systematic review of studies that reported data about the effect of PVR in patients with repaired tetralogy of Fallot that developed pulmonary insufficiency, until December 2012. The variables chosen to represent the benefit were both right ventricular (RV) and left ventricular measures, QRS duration, and functional class. The principal summary measures were difference in means with 95% confidence interval and p values (considered statistically significant when p < 0.05). The differences in means were combined across studies with the weighted DerSimonian-Laird random effects model. Meta-analysis, sensitivity analysis, and meta-regression were completed with the software Comprehensive Meta-Analysis (version 2, Biostat, Inc., Englewood, New Jersey). Forty-eight studies involving 3,118 patients met the eligibility criteria. The pooled 30-day mortality was 0.87% (47 studies; 27 of 3,100 patients); the pooled 5-year mortality was 2.2% (24 studies; 49 of 2,231 patients); the pooled 5-year re-PVR was 4.9% (15 studies; 88 of 1,798 patients). The results of this meta-analysis demonstrate that after PVR: 1) the RV experiences improvement of its volumes and function; 2) the left ventricle experiences improvement of its function; 3) QRS duration decreases; 4) symptoms improve; 5) pre-operative RV geometry modulates the effect of PVR; and 6) there is important heterogeneity of the effects among the studies, and few publication biases. In conclusion, PVR seems to be a positive approach in the analyzed scenario. (C) 2013 by the American College of Cardiology Foundation