The present meta-analysis aimed to determine the outcomes and effect on right ventricular
(RV) function of surgical pulmonary valve replacement (PVR) in patients after repair
of tetralogy of Fallot. The reported outcomes of surgical PVR in children and adults
after tetralogy of Fallot repair were from relatively small observational studies.
The PubMed database was searched from its inception to April 2009. Observational studies
reporting on the following outcomes measures after surgical PVR were reviewed: early
and late all-cause mortalities, the redo-PVR rate, and changes in the indexed RV volumes,
ejection fraction, and QRS duration after PVR. Of the 305 citations screened, 15 met
the criteria and were analyzed. The pooled early mortality rate (n = 595) was 2.1%
(95% confidence interval [CI] 1.1% to 4.0%). The late mortality rate was 0.5%/patient-year
(95% CI 0.2% to 0.8%/patient-year), and the redo-PVR rate was 1.9%/patient-year (95%
CI 1.3% to 2.5%/patient-year). Data on RV volumes and ejection fractions were available
from 5 studies (n = 141). The pooled mean difference in the indexed RV end-diastolic
and end-systolic volume was −63 ml/m2 (95% CI −55 to −72) and −37 ml/m2 (95% CI −30 to −45), respectively. No significant changes in the pooled mean difference
of the RV ejection fraction (95% CI −1% to 3%) or QRS duration (95% CI −10 to 1 ms)
were observed. In conclusion, surgical PVR in patients after tetralogy of Fallot repair
has been associated with low early and late mortality and significant decreases in
RV volumes but no changes in the RV ejection fraction or QRS duration.
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Article info
Publication history
Accepted:
March 22,
2010
Received in revised form:
March 22,
2010
Received:
February 12,
2010
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
