Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-Analysis of Observational Studies.

Andrea Laurentius, Lowilius Wiyono, Anita Dominique Subali, Sisca Natalia Siagian
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Abstract

Background: Tetralogy of Fallot (ToF) is a cardiac malformation that accounts for up to 1/10 of all congenital diseases. Although surgical repair serves as a treatment of choice, it cannot be performed unless weight and anatomical key factors are favorable. The stenting of the right ventricular outflow tract (RVOT) has become an alternative palliative procedure for ToF as an option to alleviate infundibular obstruction with minimal invasion. Methods: A literature search was conducted through 7 databases, followed by the screening and independent assessment of 6 final studies, using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was then conducted using inverse variance analysis, and cumulative data were presented with forest and funnel plots. Results: Studied patients were referred for RVOT stenting due to the marked obstruction of the pulmonary blood flow, a low birth weight, or a small pulmonary artery size. The analysis revealed a significant increase in O2 saturation (mean difference [MD=18%; 13-23.78). The same trend was observed concerning an increase in the Nakata index (MD=54.59; 10.05-99.14), the right pulmonary artery diameter (MD=2.28; 1.20-3.36), and the left pulmonary artery diameter (MD=1.77; 0.22-3.32). Several complications were found, including tricuspid regurgitation and frequent premature beats. Conclusion: RVOT stenting is considered a feasible palliative treatment for ToF, with its high effectiveness in improving patients' condition, especially their pulmonary flow. While complications are scarce, several conditions should be noted, particularly for fatal complications. Finally, this study has limitations as catheterization details in studies and diverse infants' conditions may have caused potential bias.

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评价右室流出道支架置入术作为严重紫绀型法洛四联症的姑息性治疗:观察性研究的系统回顾和荟萃分析。
背景:法洛四联症是一种心脏畸形,占所有先天性疾病的1/10。虽然手术修复是一种治疗选择,但除非体重和解剖关键因素有利,否则不能进行手术。右心室流出道(RVOT)支架置入术已成为ToF的一种可选择的姑息性手术,以最小的侵入来缓解小脑房梗阻。方法:通过7个数据库进行文献检索,然后使用Newcastle-Ottawa质量评估量表(NOS)对6项最终研究进行筛选和独立评估。采用反方差分析方法进行分析,累积数据采用森林图和漏斗图。结果:所研究的患者由于明显的肺血流阻塞、低出生体重或肺动脉尺寸小而被转诊为RVOT支架置入。分析显示O2饱和度显著升高(平均差[MD=18%;13 - 23.78)。Nakata指数也有同样的上升趋势(MD=54.59;10.05-99.14),右肺动脉直径(MD=2.28;1.20-3.36),左肺动脉直径(MD=1.77;0.22 - -3.32)。发现了一些并发症,包括三尖瓣反流和频繁的早搏。结论:RVOT支架置入术是一种可行的ToF姑息性治疗方法,对改善患者病情,尤其是肺血流有较高的疗效。虽然并发症很少,但应注意一些情况,特别是致命的并发症。最后,本研究存在局限性,因为研究中的导管细节和不同的婴儿情况可能会造成潜在的偏倚。
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来源期刊
Journal of Tehran University Heart Center
Journal of Tehran University Heart Center Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.90
自引率
0.00%
发文量
46
审稿时长
12 weeks
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