Influence of staged repair and primary repair on outcomes in patients with complete atrioventricular septal defect and tetralogy of Fallot: a systematic review and meta-analysis
| Autor: | Yuriy Y Kulyabin, Evgeniy Lenko, A.V. Zubritskiy, Alexander Karaskov, Yuriy N. Gorbatykh, N. R. Nichay, Alexander Bogachev-Prokophiev, Yuriy Naberukhin |
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| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Mitral valve medicine Humans Ventricular outflow tract Abnormalities Multiple Atrioventricular Septal Defect Cardiac Surgical Procedures Child Tetralogy of Fallot Atrioventricular valve business.industry Heart Septal Defects Palliative Care Hazard ratio Odds ratio medicine.disease Treatment Outcome medicine.anatomical_structure 030228 respiratory system Cardiology Atrioventricular canal Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. 26:98-105 |
| ISSN: | 1569-9285 1569-9293 |
| DOI: | 10.1093/icvts/ivx267 |
| Popis: | Objectives Complete atrioventricular septal defect with tetralogy of Fallot is a rare congenital heart disease. The combination of these lesions occurs in about 1% of all patients with atrioventricular canal defects and in 5-6% of patients with tetralogy of Fallot. To assess the influence of surgical strategy on the survival and reintervention rate for the left atrioventricular valve and right ventricular outflow tract. Methods We analyzed all related studies since 1986. Thirty-eight articles were initially retrieved via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and Google Scholar, from which 18 retrospective studies were included in the systematic review and 8 studies in the meta-analysis. Results There was no significant difference in the 6-year survival between staged repair and primary repair [80 patients in the primary group and 81 patients in the staged group; I2 = 0%; time-to-event data Peto odds ratio 0.66, 95% confidence interval (CI) 0.3-1.5, P = 0.31; hazard ratio 0.66, 95% CI 0.3-1.3, P = 0.23]. Both groups had an equal reintervention rate for the left atrioventricular valve [75 patients in the primary group and 71 patients in the staged group; I2 = 0.26%; the Mantel-Haenszel odds ratio 0.60, 95% CI 0.22-1.68, P = 0.33], but patients who received an initial palliation had a higher rate of reoperation on the right ventricular outflow tract [I2 = 0%; the Mantel-Haenszel odds ratio 0.27, 95% CI 0.27-0.9988, P = 0.05]. Conclusions Results of this meta-analysis reveal no difference in 6-year survival and reoperation rate for the left atrioventricular valve; however, patients who underwent staged repair had a higher rate of reintervention for the right ventricular outflow tract, which could be related to initially poor pulmonary bed anatomy. Therefore, both the primary repair and the staged repair are acceptable options for repair of complete atrioventricular septal defect with tetralogy of Fallot. The choice of surgical strategy must consider the anatomy of the pulmonary bed, patient condition and associated anomalies, which could affect surgical risk. |
| Databáze: | OpenAIRE |
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