Mortality and Survival after Norwood Procedure Comparison between Shunt Type in Patients with Hypoplastic Left Heart Syndrome or Its Variants: A Systematic Review and Meta-Analysis Study

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2023-05-31 DOI:10.1155/2023/8534205

A. Arnaout, Yaman Nerabani, Hassan Alhaj Ali, Mohamad Zaher Shahrour, M. Fallaha, I. Arnaout, Ahmad Sajee, Mohamad Morjan, Hussein Al-Kanj

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引用次数: 0

Abstract

Background. In the Norwood procedure, a conduit is performed either from the subclavian artery to the pulmonary artery, Blalock–Taussig shunt (mBTs), or from the right ventricle to the pulmonary artery (RV-PA shunt). There are some concerns regarding the two shunts and which one is better according to morbidity and mortality in patients with hypoplastic left heart syndrome or its variants. Methods. We systematically searched PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases from inception to 04/June/2021 to collect articles reporting a comparison of RV-PA shunt and mBTs. Results. Our meta-analysis showed that the mortality rate after 6 months, 1, 2, 3, 4, 5, and 6 years for the mBTS group was 16.3%, 28.6%, 34.8%, 42.4%, 44.6%, 45.1%, and 39.6%, respectively, and for the RV-PAS, 14.8%, 26.6%, 31%, 40.1%, 36.1%, 37.5%, and 34.0%, respectively. The mortality rate was significantly higher in the mBTs group at 1 and 2 years; otherwise, there is no significance differences. Overall complications rate was higher in the mBTs group than in the RV-PAs group (17.8% vs. 8.5%). In contrast, the rate of cardiac complications was higher in the RV-PAS group. Conclusions. The RV-PA shunt had lower mortality and overall complications rate than mBT shunt at the short-term outcome within the first two years, but at the long term, there was no difference between the two shunts. On the other hand, the mBT shunt had a lower incidence of cardiac complications at the early stage after the operations. However, some studies are poor due to the difficulties in conducting original research in this field. Therefore, we recommend conducting systematic reviews and original studies to compare these and other therapeutic procedures for these patients.

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左心发育不全综合征或其变体患者分流类型的诺伍德手术后死亡率和生存率比较:一项系统回顾和荟萃分析研究

背景。在Norwood手术中，从锁骨下动脉到肺动脉(blallock - taussig分流术，mBTs)或从右心室到肺动脉(RV-PA分流术)进行导管。根据左心发育不全综合征或其变体患者的发病率和死亡率，关于两种分流术以及哪一种分流术更好的问题存在一些担忧。方法。我们系统地检索了PubMed、Web of Science、Scopus、Embase和Cochrane Library数据库，从成立到2021年6月4日收集了报道RV-PA分流术和mbt比较的文章。结果。我们的荟萃分析显示，mBTS组在6个月、1、2、3、4、5和6年后的死亡率分别为16.3%、28.6%、34.8%、42.4%、44.6%、45.1%和39.6%，而RV-PAS组的死亡率分别为14.8%、26.6%、31%、40.1%、36.1%、37.5%和34.0%。mbt组在1年和2年时的死亡率显著高于对照组;否则，无显著性差异。mbt组的总并发症发生率高于RV-PAs组(17.8%比8.5%)。相反，RV-PAS组心脏并发症发生率较高。结论。RV-PA分流术在前两年的短期预后中死亡率和总并发症发生率低于mBT分流术，但在长期预后中，两种分流术之间没有差异。另一方面，mBT分流术术后早期心脏并发症发生率较低。然而，由于难以进行原创性研究，一些研究较差。因此，我们建议对这些患者进行系统评价和原始研究，以比较这些治疗方法和其他治疗方法。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.