Impact of Pulsatile Bidirectional Cavopulmonary Shunt on Pre-Fontan Hemodynamics in Single Ventricle Physiology: A Meta-Analysis Reveals Favorable Outcomes.

Ketut Putu Yasa, I Wayan Sudarma, I Komang Adhi Parama Harta, Putu Febry Krisna Pertiwi
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Abstract

Purpose: This study aims to determine the outcomes of maintaining antegrade pulmonary blood flow (APBF) during the bidirectional cavopulmonary shunt (BCPS) procedure in patients with single ventricle physiology undergoing staged palliative surgeries.

Methods: A systematic search of electronic databases was conducted and focused on studies comparing pulsatile BCPS (with APBF) with non-pulsatile BCPS (without APBF). Outcomes were categorized into early (post-BCPS) and late (pre-Fontan). Data were analyzed using Mantel-Haenszel random effects model with odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). The study protocol was registered in the PROSPERO (CRD42024586369).

Results: A total of 17 studies with 2504 patients were included. There was no significant difference in 30-day mortality (OR 1.11, 95% CI: 0.61-2.04, p = 0.73), but pulsatile BCPS led to a higher rate of prolonged chest drainage (OR 2.45, 95% CI: 1.43-4.20, p <0.001). Pulsatile BCPS resulted in significantly higher SaO2 in both post-BCPS (MD 3.33%, 95% CI: 2.70-3.97, p <0.001) and pre-Fontan (MD 2.91%, 95% CI: 2.51-3.31, p <0.001). The Nakata index was also higher in the pulsatile group (MD 30.67, 95% CI: 16.68-44.65, p <0.001).

Conclusions: Pulsatile BCPS can optimize pre-Fontan hemodynamics by improving oxygenation and pulmonary artery development. However, the increased risk of prolonged chest drainage requires careful patient selection and monitoring.

脉动式双向腔室肺分流术对单心室前血流动力学的影响:一项荟萃分析显示了有利的结果。
目的:本研究旨在确定在进行分阶段姑息性手术的单心室生理障碍患者进行双向腔室肺分流术(BCPS)期间维持顺行肺血流量(APBF)的结果。方法:系统检索电子数据库,重点比较脉动性BCPS(带APBF)和非脉动性BCPS(不带APBF)的研究。结果分为早期(bcps后)和晚期(fontan前)。数据分析采用Mantel-Haenszel随机效应模型,采用优势比(ORs)和均值差异(MDs), 95%置信区间(ci)。研究方案已在PROSPERO中注册(CRD42024586369)。结果:共纳入17项研究,2504例患者。两组患者30天死亡率无显著差异(OR 1.11, 95% CI: 0.61-2.04, p = 0.73),但搏动性BCPS导致两组患者延长胸腔引流的发生率较高(OR 2.45, 95% CI: 1.43-4.20, p = 2) (MD 3.33%, 95% CI: 2.70-3.97, p)。结论:搏动性BCPS可以通过改善氧合和肺动脉发育来优化fontan前的血流动力学。然而,延长胸腔引流的风险增加,需要仔细选择和监测患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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