Pulmonary Valve Replacement for Pulmonary Regurgitation in Adults With Tetralogy of Fallot: A Meta-analysis—A Report for the Writing Committee of the 2019 Update of the Canadian Cardiovascular Society Guidelines for the Management of Adults With Congenital Heart Disease
| Autor: | Annie Dore, Paul Khairy, Pierre-Luc Bernier, François-Pierre Mongeon, Rachel M. Wald, Candice K. Silversides, Ariane Marelli, Walid Ben Ali, Judith Therrien, Nancy Poirier, Ismail Bouhout, Frederic Dallaire |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Heart Defects Congenital Male Canada medicine.medical_specialty Heart disease 030204 cardiovascular system & hematology Ventricular tachycardia 03 medical and health sciences 0302 clinical medicine Cause of Death Internal medicine medicine Humans 030212 general & internal medicine Societies Medical Tetralogy of Fallot Cause of death Heart Valve Prosthesis Implantation Pulmonary Valve Ejection fraction business.industry Disease Management Odds ratio Canadian Cardiovascular Society medicine.disease Survival Analysis Pulmonary Valve Insufficiency eye diseases 3. Good health Treatment Outcome Cardiovascular Diseases Practice Guidelines as Topic Cardiology Female sense organs Cardiology and Cardiovascular Medicine business Forecasting Cohort study |
| Zdroj: | Canadian Journal of Cardiology. 35:1772-1783 |
| ISSN: | 0828-282X |
| Popis: | Background There is no systematic evidence review of the long-term results of surgical pulmonary valve replacement (PVR) dedicated to adults with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation. Methods Our primary objective was to determine whether PVR reduced long-term mortality in adults with rTOF compared with conservative therapy. Secondary objectives were to determine the postoperative incidence rate of death, the changes in functional capacity and in right ventricular (RV) volumes and ejection fraction after PVR, and the postoperative incidence rate of sustained ventricular arrhythmias. A systematic search of multiple databases for studies was conducted without limits. Results No eligible randomized controlled trial or cohort study compared outcomes of PVR and conservative therapy in adults with rTOF. We selected 10 cohort studies (total 657 patients) reporting secondary outcomes. After PVR, the pooled incidence rate of death was 1% per year (95% confidence interval [CI] 0-1% per year) and the pooled incidence rate of sustained ventricular arrhythmias was 1% per year (95% CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24). Indexed RV end-diastolic (−61.29 mL/m2, −43.64 to −78.94 mL/m2) and end-systolic (−37.20 mL/m2, −25.58 to −48.82 mL/m2) volumes decreased after PVR, but RV ejection fraction did not change (0.19%, −2.36% to 2.74%). The effect of PVR on RV volumes remained constant regardless of functional status. Conclusion Studies comparing PVR and conservative therapy exclusively in adults with rTOF are lacking. After PVR, the incidence rates of death and ventricular tachycardia are both 1 per 100 patient-years. Pooled analyses demonstrated an improved functional status and a reduction in RV volumes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect