scholarly journals Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaodong Wei ◽  
Tiange Li ◽  
Yunfei Ling ◽  
Zheng Chai ◽  
Zhongze Cao ◽  
...  

Abstract Background Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. Pulmonary regurgitation is the most common and severe comorbidity after transannular patch (TAP) repair of TOF patients. It has not been confirmed whether a TAP repair with monocusp valve reconstruction would benefit TOF patients in perioperative period compared to those without monocusp valve reconstruction. The purpose of the study is to review and analyze all clinical studies that have compared perioperative outcomes of TOF patients undergoing TAP repair with or without monocusp valve reconstruction and conduct a preferable surgery. Methods Eligible studies were identified by searching the electronic databases. The year of publication of studies was restricted from 2000 till present. The primary outcome was perioperative mortality, and secondary outcomes included cardiopulmonary bypass time, aortic cross-clamp time, ventilation duration, ICU length of stay, hospital length of stay, perioperative right ventricular outflow tract (RVOT) pressure gradient, and moderate or severe pulmonary regurgitation (PR). The meta-analysis and forest plots were drawn using Review Manager 5.3. Statistically significant was considered when p-value ≤ 0.05. Results Eight studies were included which consisted of 8 retrospective cohort study and 2 randomized controlled trial. The 10 studies formed a pool of 526 TOF patients in total, in which are 300 undergoing TAP repair with monocusp valve reconstruction (monocusp group) compared to 226 undergoing TAP repair without monocusp valve reconstruction (non-monocusp group). It demonstrated no significant differences between two groups in perioperative mortality (OR = 0.69, 95% CI 0.20–2.41, p = 0.58). It demonstrated significant differences in perioperative cardiopulmonary bypass time (minute, 95% CI 17.93–28.42, p < 0.00001), mean length of ICU stay (day, 95% CI − 2.11–0.76, p < 0.0001), and the degree of perioperative PR (OR = 0.03, 95% CI 0.010.12, p < 0.00001). Significant differences were not found in other secondary outcomes. Conclusion Transannular patch repair with monocusp valve reconstruction have significant advantages on decreasing length of ICU stay and reducing degree of PR for TOF patients. Large, multicenter, randomized, prospective studies which focuse on perioperative outcomes and postoperative differences based on long-term follow-up between TAP repair with and without monocusp valve reconstruction are needed.

2020 ◽  
Author(s):  
Xiaodong Wei ◽  
Tiange Li ◽  
Yunfei Ling ◽  
Zheng Chai ◽  
Zhongze Cao ◽  
...  

Abstract Background: Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. Pulmonary regurgitation is the most common and severe comorbidity after transannular patch (TAP) repair of TOF patients. It has not been confirmed whether a TAP repair with monocusp valve reconstruction would benefit TOF patients in perioperative period compared to those without monocusp valve reconstruction. The purpose of the study is to review and analyze all clinical studies that have compared perioperative outcomes of TOF patients undergoing TAP repair with or without monocusp valve reconstruction and conduct a preferable surgery.Methods: Eligible studies were identified by searching the electronic databases. The primary outcome was perioperative mortality. Secondary outcomes included cardiopulmonary bypass time, aortic cross-clamp time, ventilation duration, ICU length of stay, hospital length of stay, and perioperative right ventricular outflow tract (RVOT) pressure gradient. The meta-analysis and forest plots were drawn using Review Manager 5.3. Statistically significant was considered when p-value ≤ 0.05. Results: Eight studies were included which consisted of 7 retrospective cohort study and 1 randomized controlled trial. The 8 studies formed a pool of 526 TOF patients in total, in which are 300 undergoing TAP repair with monocusp valve reconstruction (monocusp group) compared to 226 undergoing TAP repair without monocusp valve reconstruction (non-monocusp group). It demonstrated significant differences between two groups in perioperative cardiopulmonary bypass time (21.86, 95% CI 16.51-27.21), perioperative aortic cross-clamp time (11.20, 95% CI 1.06 - 21.34), mean length of ICU stay (-1.55, 95% CI -3.90 - -0.81), and the degree of perioperative PR (OR=0.02, 95% CI 0.00 - 0.15).Conclusion: Transannular patch repair with monocusp valve reconstruction seems to have significant advantages on some perioperative outcomes of TOF patients. Large, multicenter, randomized, prospective studies focusing on differences between TAP repair with and without monocusp valve reconstruction are needed.


2019 ◽  
Author(s):  
Xiaolei Wang ◽  
Shanshan Meng ◽  
Yaowei Hu ◽  
Kehang Duan ◽  
Feng Wei

Abstract Background The purpose of this meta-analysis was to examine the impact of preoperative biliary drainage (PBD) on the perioperative outcomes of pancreatoduodenectomy (PD) in patients with total bilirubin >100 umol/L.Methods In this meta-analysis, studies that compared the perioperative outcomes of PBD and non-PBD patients with total bilirubin >100 umol/L, and were published in EMBASE, PubMed, the Cochrane library, Web of Science, VIP database, Wanfang data, Chinese biomedical literature and CNKI database from inception up to October 2019 were included. The odds ratios (OR) or mean differences were calculated with 95% confidence intervals (CI).Results Nine trials with 744 patients, which compared PBD (267 patients) with non-PBD (477 patients), were included. There was no significant difference in perioperative mortality between these two groups (OR: 0.51, 95% CI: 0.19 to 1.39; P =0.19). Postoperative hospital stay (mean difference: -2.35, 95% CI: -3.70 to -1.00; P =0.0007), operating time (mean difference: -33.03, 95% CI: -44.14 to 21.93; P <0.00001), estimated blood loss (mean difference: -141.18, 95% CI: -213.25 to -69.11; P =0.0001) and overall morbidity (OR: 0.68, CI: 0.48 to 0.95; P =0.02) were significantly lower in the PBD group than in the non-PBD group.Conclusion Patients who received PBD had similar perioperative mortality, but had decreased postoperative hospital stay, operating time, estimated blood loss and overall morbidity, when compared to patients without PBD. Therefore, PBD should be routinely performed for patients planned for PD with a total bilirubin of >100 umol/L.


Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 350-362 ◽  
Author(s):  
Idris Ghijselings ◽  
Dirk Himpe ◽  
Steffen Rex

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Elizabeth H Stephens ◽  
Bryan L Wolfe ◽  
Abhinav A Talwar ◽  
Angira Patel ◽  
Joseph Camarda ◽  
...  

Introduction: While valve-sparing repair is ideal for Tetralogy of Fallot (TOF), it’s durability and which patients may benefit from a transannular patch remains unclear. To this end, we reviewed our experience with valve-sparing TOF repair. Methods: Retrospective review was performed of all primary TOF operations at our institution from 1/2008 to 12/2018. Standard demographic, operative, and echo data were collected, along with clinical outcomes. Transannular patch and valve-sparing repair groups were then compared. Results: Sixty-eight patients underwent TOF repair with a mean age of 4.1±2.2 months and weight of 5.7±1.8 kg. There was no difference in age or weight between patients who underwent a transannular patch repair and valve-sparing repair (Table). There was also no difference in the frequency of hypercyanotic spells or beta-blocker use. As expected the pre-operative pulmonary valve size and z-score were significantly different between groups. Bypass times were longer in the transannular patch group (176±40 vs. 144±40 minutes, p=0.005). There were no differences in post-operative complications. At last follow-up (median 41.5 months) there was a trend of a higher peak pulmonary valve gradient (p=0.07) in the valve-sparing group, but no difference in pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from -2.3±1.0 on pre-discharge echocardiogram to -1.2±1.6 on last follow-up, with the peak gradient on pre-discharge 20 (33) mmHg stable on last follow-up at 18 (29) mmHg and degree of pulmonary regurgitation stable. There was one reoperation in the cohort: a pulmonary valve replacement in a patient who had undergone a transannular patch repair 6 years prior. Conclusions: Valve-sparing TOF patients demonstrated stable repairs with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from re-intervention during follow-up.


2019 ◽  
Vol 10 (5) ◽  
pp. 616-623 ◽  
Author(s):  
Rohit S. Loomba ◽  
Saul Flores ◽  
Enrique G. Villarreal ◽  
Ronald A. Bronicki ◽  
Robert H. Anderson

Background: We performed a meta-analysis of studies to determine whether the modified single-patch technique offers benefits when compared to the two-patch repair. The postoperative outcomes examined in this study were cardiopulmonary bypass time, cross-clamp time, duration of mechanical ventilation, intensive care unit length of stay, total hospital length of stay, need for reoperation, need for reoperation for left ventricular outflow tract obstruction or left atrioventricular valve regurgitation, need for pacemaker implantation, and mortality during follow-up. Methods: A review was conducted to identify studies comparing a modified single-patch repair versus two-patch repair. A fixed-effects model was utilized for end points with low heterogeneity and a random-effects model for end points with significant heterogeneity. Meta-regression was also performed to determine the influence of other factors on the variables of interest. Results: A total of 964 unique manuscripts were screened, with 10 being included in the final analyses. There were a total of 724 patients, with 353 (49%) having undergone repair utilizing a modified single-patch repair. Mean age at repair for modified single-patch repair and two-patch repair was 8.81 and 9.03 months, respectively. Significant differences were noted in cardiopulmonary bypass time and cross-clamp time with mean difference of −28.53 and −22.69 minutes, respectively. In comparison to the two-patch repair, both times were decreased in modified single-patch repair. No significant difference was noted in any other variables. Conclusions: Modified single-patch repair for atrioventricular septal defects requires less cardiopulmonary bypass and cross-clamp time but does not significantly impact the examined postoperative outcomes.


Vascular ◽  
2021 ◽  
pp. 170853812110251
Author(s):  
Hatim Alsusa ◽  
Abbas Shahid ◽  
George A Antoniou

Background Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. Methods Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. Results Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. Conclusion The evidence suggests that EVAR confers a significant benefit on perioperative mortality.


2020 ◽  
Author(s):  
Semagn Mekonnen Abate ◽  
Bahiru Mantefardo ◽  
Bivash Basu

Abstract Background: Surgery during the COVID-19 pandemic is too challenging globally especially for low and middle-income countries in which the limping health care system is broken with low testing capacity, sub-optimal postoperative care, lack of anesthesia machine filters, and limited personal protective equipment. Body of evidence is lacking on the prevalence of perioperative outcomes of patients with COVID-19. Therefore, this study is aimed to provide the global prevalence of perioperative outcomes of patients with COVID-19.Methods: A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 2019 to August 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting the prevalence of mortality were included.Results: A total of 515 articles were identified from different databases and 50 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The Meta-Analysis revealed that the global prevalence of perioperative mortality among COVID-19 patients was 20% (95% CI: 15 to 26). The Meta-Analysis also revealed that the rate of postoperative ICU admission was 15% (95% confidence interval (CI):10 to 21).Conclusion: There is one death for every five COVID-19 patients undergoing surgical procedures which entails mitigating strategies to decrease perioperative mortality, provide less risky anesthetic techniques, and alternative management other than surgical procedures.Registration: This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.


2020 ◽  
Author(s):  
Mingtang Ye ◽  
Xiaodong Zang ◽  
Peicheng Ding ◽  
Ruonan Wang ◽  
Feng Chen ◽  
...  

Abstract Introduction: Hydroxyethyl starch (HES) has been widely used for volume expansion, but its safety as priming fluid for cardiopulmonary bypass has been questioned recently. The aim of this meta-analysis is to compare the safety of albumin and hydroxyethyl starch as priming fluid for cardiopulmonary bypass.Methods: Pubmed, Embase database and Cochrane Library were searched for randomized controlled trials (RCTs) involving patients who received HES or albumin as priming fluid for cardiopulmonary bypass in cardiac surgery published up to October 2019. Two reviewers independently extracted the valid data, including the length of ICU stay, ventilator time, the length of hospital stay, crystal volume, fresh frozen plasma, platelet input, blood loss, blood platelet count. hemoglobin value, fibrin, APTT, PT, urea, creatinine and urine volume. Meta-analysis was performed with revman version 5.3. Results: Total 9 RCTs involving 452 patients were included in this meta-analysis. Compared with albumin, HES had similar effects on the length of ICU stay(MD = 0.70;95%CI:-0.14 to 1.55;P = 0.10;I2 = 89%);ventilation time(MD = 2.31 ;95%CI-3.93 to 8.55;P = 0.47,I2 = 60%); the length of hospital stay(MD = -0.31;95% CI:-2.00 to 1.37; P = 0.71 ;I2 = 0%); crystal volume(SMD = 0.26;95% CI:-0.09 to 0.61; P = 0.15;I2 = 0%); fresh frozen plasma(SMD = 0.25;95%CI:-0.08 to 0.59;P = 0.66;I2 =0%); platelet input(SMD =-0.17;95% Cl:-0.59 to 0.26;P =0.45;I2 = 0%);blood loss (SMD =0.31;95% Cl:-0.01 to 0.63;P = 0.06;I2 =29%);platelet count (SMD =-0.21;95% cl :-0.54 to 0.11; P = 0.20;I2 = 29% );hemoglobin value(SMD =0.1;95% CI: -0.15 to 0.36;P = 0.42; I2 = 0% ); fibrin (SMD =0.12;95% CI: -0.19 to 0.44 ; P = 0.45; I2 = 0% );APTT(MD =1.13;95% CI: -2.06 to 4.32 ; P = 0.49; I2 = 0%);PT(MD =0.10;95% CI: -0.21 to 0.40,P = 0.52; I2 = 0%);creatinine(SMD =0.09;95% CI: -0.32 to 0.50 ; P = 0.66; I2 = 51% );urine volume(SMD =0.11;95% CI: -0.26 to 0.48 ; P = 0.55; I2 = 43% ).but did not increase urea (SMD =-0.46;95% CI: -0.81 to -0.11; P = 0.01; I2 = 0%).Conclusions: HES was safe and effective compared to albumin as priming fluid for cardiopulmonary bypass because it did not affect renal function, coagulation function, liquid input, or the length of ICU stay and ventilation time of patients.


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