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The Annals of Thoracic Surgery Mar 2022The benefits of pulmonary valve replacement (PVR) for pulmonary insufficiency in patients with repaired tetralogy of Fallot are still incompletely understood, and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The benefits of pulmonary valve replacement (PVR) for pulmonary insufficiency in patients with repaired tetralogy of Fallot are still incompletely understood, and optimal timing remains challenging.
METHODS
We systematically reviewed databases (PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials /Cochrane Controlled Trials Register, ClinicalTrials.gov, Scientific Electronic Library Online, Literatura Latino Americana em Ciências da Saúde, and Google Scholar) and reference lists of relevant articles for studies about PVR in repaired tetralogy of Fallot patients that reported any of the following outcomes: mortality and redo PVR rates, right ventricular (RV) and left ventricular measures, QRS duration, cardiopulmonary exercise test results, or brain natriuretic peptide. In addition to calculating the pooled treatment effects using a random-effects meta-analysis, we evaluated the effect of preoperative measures on PVR outcomes using meta-regressions.
RESULTS
Eighty-four studies involving 7544 patients met the eligibility criteria. Pooled mortality at 30 days, 5 years, and 10 years after PVR was 0.87% (63 of 7253 patients, 80 studies), 2.7% (132 of 4952 patients, 37 studies), and 6.2% (510 of 2765 patients, 15 studies), respectively. Pooled 5- and 10-year redo PVR rates were 3.7% (141 of 3755 patients, 23 studies) and 16.8% (172 of 3035 patients, 16 studies), respectively. The results of the previous meta-analysis could be confirmed. In addition, we demonstrated that after PVR (1) QRS duration, cardiopulmonary exercise test results, and RV and left ventricular measures longitudinal strain do not significantly change; (2) brain natriuretic peptide decreases; and (3) greater indexed RV end-diastolic and end-systolic volumes are associated with lower chances of RV volume normalization after PVR.
CONCLUSIONS
This updated meta-analysis provides evidence about the benefits of PVR.
Topics: Heart Valve Prosthesis Implantation; Humans; Natriuretic Peptide, Brain; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Tetralogy of Fallot; Treatment Outcome
PubMed: 33378694
DOI: 10.1016/j.athoracsur.2020.11.040 -
Seminars in Thoracic and Cardiovascular... 2023The range of valve choices available to the cardiac surgeon for placement in the pulmonary position continues to expand. This article will provide a brief compendium of...
The range of valve choices available to the cardiac surgeon for placement in the pulmonary position continues to expand. This article will provide a brief compendium of the most clinically relevant among these choices and review the contemporary literature regarding their relative durability as well as risk factors for structural valve deterioration and reintervention. The unique advantages and disadvantages of each of these valve choices will be discussed as they pertain to unique patient-specific factors, including patient size and the anatomy of the right ventricular outflow tract, that inform the choice of one prosthesis over another. Finally, general principles regarding the approach to valve choice, and future directions will be discussed.
Topics: Humans; Pulmonary Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Treatment Outcome; Pulmonary Valve Insufficiency; Bioprosthesis; Surgical Instruments
PubMed: 35139432
DOI: 10.1053/j.semtcvs.2022.01.006 -
Seminars in Thoracic and Cardiovascular... 2022
Topics: Humans; Pulmonary Valve; Treatment Outcome; Pulmonary Valve Insufficiency; Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation
PubMed: 35584775
DOI: 10.1053/j.semtcvs.2022.05.006 -
JACC. Cardiovascular Interventions Mar 2018
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Artery; Pulmonary Valve; Pulmonary Valve Insufficiency
PubMed: 29566800
DOI: 10.1016/j.jcin.2018.02.017 -
International Journal of Clinical... Oct 2014In this review, we discuss right-sided heart valve disease, namely tricuspid regurgitation (TR), tricuspid stenosis, pulmonary regurgitation, pulmonary stenosis and...
In this review, we discuss right-sided heart valve disease, namely tricuspid regurgitation (TR), tricuspid stenosis, pulmonary regurgitation, pulmonary stenosis and right-sided endocarditis. These are frequently seen in conjunction with other diseases, making assessment of their significance more difficult, but it has become increasingly clear that moderate or severe right-sided heart valve disease, in particular TR, is associated with worse prognosis. There remain large gaps in our knowledge of medical and interventional treatment, but in this article we outline what is known about the causes, presentation and management of these commonly seen conditions.
Topics: Heart Valve Diseases; Humans; Prognosis; Pulmonary Valve Insufficiency; Tricuspid Valve Insufficiency; Tricuspid Valve Stenosis
PubMed: 25269950
DOI: 10.1111/ijcp.12485 -
JACC. Cardiovascular Interventions Sep 2022
Topics: Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot; Treatment Outcome
PubMed: 36137693
DOI: 10.1016/j.jcin.2022.05.021 -
JACC. Clinical Electrophysiology Oct 2021
Topics: Cardiac Surgical Procedures; Defibrillators, Implantable; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot
PubMed: 34674838
DOI: 10.1016/j.jacep.2021.03.014 -
World Journal For Pediatric &... May 2021Stented bioprosthesis implant at surgical pulmonary valve replacement (PVR) ideally should be 25 to 27 mm to facilitate future percutaneous PVR. This often requires...
BACKGROUND
Stented bioprosthesis implant at surgical pulmonary valve replacement (PVR) ideally should be 25 to 27 mm to facilitate future percutaneous PVR. This often requires accommodating 35 to 37 mm diameter sewing ring in the pulmonary position and requires anterior patch augmentation of the right ventricular outflow tract (RVOT). We present a novel "interposition" technique of PVR that allows upsizing the valve without RVOT patch augmentation.
METHODS
Using standard cardiopulmonary bypass, the main pulmonary artery (MPA) is dissected and transected at an appropriate level. The remnants of pulmonary valve leaflets are excised. The valve stent posts are telescoped into distal MPA, the MPA continuity is restored by end-to-end anastomosis of the proximal and distal MPA, with the interposed prosthetic valve sewing ring in the suture line between the two edges of the MPA with the bulk of the sewing ring extravascular.
RESULT
A total of seven patients (tetralogy of Fallot, three; congenital pulmonary stenosis, four; age range: 15-33 years) underwent the procedure. No patient required RVOT patch augmentation, all patients were extubated in the operating room and were fast-tracked to recovery. Our proposed technique of PVR has the following advantages: accommodate larger size valve, eliminates risk of a paravalvar leak, coronary compression, and anterior tilting of the prosthesis.
CONCLUSION
The valve interposition technique avoids the need for RVOT patch, allows implantation of an adequate sized prosthetic valve, maintains native geometry of the pulmonary artery without the risk of tilting of the prosthesis, and eliminates the risk of paravalvular regurgitation and left coronary compression.
Topics: Adolescent; Adult; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Tetralogy of Fallot; Treatment Outcome; Young Adult
PubMed: 33942689
DOI: 10.1177/21501351211000283 -
The Journal of Thoracic and... Oct 2022
Topics: Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot; Treatment Outcome
PubMed: 35337677
DOI: 10.1016/j.jtcvs.2022.02.043 -
Hellenic Journal of Cardiology : HJC =... 2022The majority of patients with congenital heart disease (CHD) who have undergone open heart surgery during childhood are possible candidates for additional transcatheter... (Review)
Review
The majority of patients with congenital heart disease (CHD) who have undergone open heart surgery during childhood are possible candidates for additional transcatheter or surgical interventions. One fifth of these conditions usually involve the right ventricular outflow tract (RVOT). Percutaneous pulmonary valve replacement (PPVR) has been widely established as an alternative, less invasive option to surgical pulmonary valve replacement (SPVR). The variability of RVOT anatomy and size, the relative course of the coronary arteries, and the anatomy of the pulmonary artery branches are factors that determine the success of the intervention and the complication rates. Careful and reliable pre-interventional imaging warrants the selection of suitable candidates and minimizes the risk of complications. 2D and 3D fluoroscopy have been extensively used during pre- and peri-interventional assessment. Established imaging techniques such as cardiovascular magnetic resonance (CMR) and computed tomography (CT) and newer techniques such as fusion imaging have proved to be efficient and reliable tools during pre-procedural planning in patients assessed for PPVR.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Heart Defects, Congenital; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Treatment Outcome
PubMed: 35863726
DOI: 10.1016/j.hjc.2022.06.004