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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References
- Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA. 2000; 283: 2008-2012
- Pulmonary valve replacement late after repair of tetralogy of Fallot.Ann Thorac Surg. 1997; 64: 526-530
- Late pulmonary valve replacement after repair of tetralogy of Fallot.J Thorac Cardiovasc Surg. 2001; 121: 344-351
- Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot.Circulation. 2001; 103: 2489-2494
- Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of Fallot.Ann Thorac Surg. 2002; 73: 1794-1800
- Expanding the indications for pulmonary valve replacement after repair of tetralogy of Fallot.Ann Thorac Surg. 2003; 76: 1066-1071
- Early replacement of pulmonary valve after repair of tetralogy: is it really beneficial?.Eur J Cardiothorac Surg. 2004; 25: 728-734
- Severe pulmonary regurgitation late after total repair of tetralogy of Fallot: surgical considerations.Pediatr Cardiol. 2004; 25: 466-471
- Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair.Am J Cardiol. 2005; 95: 779-782
- Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance.Eur Heart J. 2005; 26: 2721-2727
- Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot.Eur Heart J. 2006; 27: 1478-1484
- Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance.Circulation. 2007; 116: 545-551
- Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot.Eur J Cardiothorac Surg. 2007; 31: 654-658
- Outcome of pulmonary valve replacements in adults after tetralogy repair: a multi-institutional study.Congenit Heart Dis. 2008; 3: 162-167
- Assessment of myocardial function in pediatric patients with operated tetralogy of Fallot: preliminary results with 2D strain echocardiography.Pediatr Cardiol. 2008; 29: 718-725
- Consequences of a selective approach toward pulmonary valve replacement in adult patients with tetralogy of Fallot and pulmonary regurgitation.J Thorac Cardiovasc Surg. 2008; 135: 50-55
- Pulmonary valve replacement in patients with tetralogy of Fallot and pulmonary regurgitation: early surgery similar to optimal timing of surgery?.Eur Heart J. 2005; 26: 2614-2615
- Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot.Circulation. 2002; 106: 1703-1707
- Current approaches to pulmonary regurgitation.Eur J Cardiothorac Surg. 2008; 34: 576-580
- Right ventricular myocardial dysfunction in adult patients late after repair of tetralogy of Fallot.Int J Cardiol. 2004; 94: 213-220
- Tissue Doppler imaging and brain natriuretic peptide levels in adults with repaired tetralogy of Fallot.J Am Soc Echocardiogr. 2005; 18: 1149-1154
- Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of Fallot.Int J Cardiovasc Imaging. 2009; 25: 669-676
- Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot: restrictive physiology predicts superior exercise performance.Circulation. 1995; 91: 1775-1781
- QRS prolongation is associated with inducible ventricular tachycardia after repair of tetralogy of Fallot.Am J Cardiol. 1997; 80: 160-163
- Right ventricular mechanics and QRS duration in patients with repaired tetralogy of Fallot: implications of infundibular disease.Circulation. 2007; 116: 1532-1539
- Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia.Circulation. 2009; 119: 445-451
- Impact of right ventricular volume overload on three-dimensional global left ventricular mechanical dyssynchrony after surgical repair of tetralogy of Fallot.Am J Cardiol. 2008; 102: 1731-1736
- Impact of right ventricular dilation on left ventricular myocardial deformation in patients after surgical repair of tetralogy of Fallot.Am J Cardiol. 2009; 104: 1264-1270
- Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome.Circulation. 2008; 117: 1964-1972
- Delayed improvement of right ventricular diastolic function and regression of right ventricular mass after percutaneous pulmonary valve implantation in patients with congenital heart disease.Am Heart J. 2009; 158: 40-46
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.