Matteo Ponzoni, Danila Azzolina, Luca Vedovelli, Dario Gregori, Vladimiro L Vida, Massimo A Padalino
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引用次数: 0
Abstract
To date, evidence supporting the efficacy of tricuspid valve (TV) repair in interrupting the progression of systemic right ventricular (RV) adverse remodeling in hypoplastic left heart syndrome (HLHS) is conflicting. We conducted a systematic review and meta-analysis of scientific literature to assess the impact of TV repair in effectively modifying the prognosis of patients with HLHS. We conducted a systematic review of PubMed, Web of Science, and Scopus databases. A random-effect meta-analysis was performed and transplant-free survival, freedom from TV regurgitation, and TV reoperation data were reconstructed using the published Kaplan-Meier curves. Nine studies were included, comprising 203 HLHS patients undergoing TV repair and 323 HLHS controls. The estimated transplant-free survival at 1, 5, and 10 years of follow-up was 75.5% [95% confidence interval (CI) = 67.6-84.3%], 63.6% [95% CI = 54.6-73.9%], and 61.9% [95% CI = 52.7-72.6%], respectively. Transplant-free survival was comparable to HLHS peers without TV regurgitation (p = 0.59). Five-year freedom from recurrence of TV regurgitation and freedom from TV reoperation was 57% [95% CI = 46.7-69.7%] and 63.6% [95% CI = 54.5-74.3%], respectively. Younger age and TV repair at the time of Norwood operation increased the risk of TV regurgitation recurrence and the need for TV reoperation. Our meta-analysis supports the efficacy of TV repair in favorably modifying the prognosis of patients with HLHS and TV regurgitation, reestablishing a medium-term transplant-free survival which is comparable to HLHS peers. However, durability of surgery and long-term fate of TV and RV performance are still unclear.
迄今为止,支持三尖瓣(TV)修复术在阻断发育不全左心综合征(HLHS)患者系统性右心室(RV)不良重塑进展方面的疗效的证据并不一致。我们对科学文献进行了系统性回顾和荟萃分析,以评估 TV 修复对有效改变 HLHS 患者预后的影响。我们对 PubMed、Web of Science 和 Scopus 数据库进行了系统回顾。我们进行了随机效应荟萃分析,并使用已发表的 Kaplan-Meier 曲线重建了无移植生存率、无 TV 返流和 TV 再次手术的数据。共纳入九项研究,包括203名接受TV修复的HLHS患者和323名HLHS对照组患者。估计随访1年、5年和10年的无移植生存率分别为75.5% [95% 置信区间(CI)= 67.6-84.3%]、63.6% [95% CI = 54.6-73.9%]和61.9% [95% CI = 52.7-72.6%]。无移植生存率与无TV反流的HLHS患者相当(P = 0.59)。五年内TV反流复发率和TV再手术率分别为57% [95% CI = 46.7-69.7%]和63.6% [95% CI = 54.5-74.3%]。年龄较小和在诺伍德手术时进行 TV 修复会增加 TV 返流复发和 TV 再次手术的风险。我们的荟萃分析证实,TV修复术能有效改善HLHS合并TV反流患者的预后,重建与HLHS患者相当的中期无移植生存率。然而,手术的持久性以及TV和RV的长期表现仍不清楚。
期刊介绍:
The editor of Pediatric Cardiology welcomes original manuscripts concerning all aspects of heart disease in infants, children, and adolescents, including embryology and anatomy, physiology and pharmacology, biochemistry, pathology, genetics, radiology, clinical aspects, investigative cardiology, electrophysiology and echocardiography, and cardiac surgery. Articles which may include original articles, review articles, letters to the editor etc., must be written in English and must be submitted solely to Pediatric Cardiology.