Systematic review and meta-analysis of pulmonary valve replacement in children and adults after surgical repair of tetralogy of fallot

Abstract

OBJECTIVES: Reported outcomes of surgical PVR in children and adults after TOF repair were based on relatively small observational studies. This systematic review and meta-analysis aimed to determine the outcomes and impact on right ventricular (RV) function of surgical pulmonary valve replacement (PVR) in patients after repair of tetralogy of Fallot (TOF). METHODS: 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, redo-PVR rate, and changes in indexed RV volumes, ejection fraction (EF), and QRS duration after PVR. RESULTS: Of the 305 citations screened, 15 met the criteria and were analyzed. Pooled early mortality (n=595) was 2.1% (95% CI, 1.1 to 4.0%). Late mortality rate was 0.5%/patient-year (95% CI, 0.2 to 0.8%/patient-year) and 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). Pooled mean differences of indexed RV end-diastolic and end-systolic volumes were -64ml/m2 (95% CI, -55 to -72ml/m2) and -37ml/m2 (95% CI, -30 to -45ml/m2), respectively. No significant changes in pooled mean difference of RV EF (95% CI, -3 to 1%) and QRS duration (95%CI, -1 to 12ms) were observed. CONCLUSIONS: Surgical PVR in patients after TOF repair is associated with low early and late mortalities and significant decrease in RV volumes, but with no changes in RV EF or QRS duration.