François-Pierre Mongeon1, Walid Ben Ali2, Paul Khairy3, Ismail Bouhout2, Judith Therrien4, Rachel M Wald5, Frederic Dallaire6, Pierre-Luc Bernier7, Nancy Poirier8, Annie Dore3, Candice Silversides5, Ariane Marelli9. 1. Adult Congenital Heart Center, Department of Specialized Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada. Electronic address: francois-pierre.mongeon@icm-mhi.org. 2. Department of surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada. 3. Adult Congenital Heart Center, Department of Specialized Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada. 4. Jewish General Hospital, McGill University, Montréal, Québec, Canada. 5. Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. 6. Division of Pediatric and Fetal Cardiology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada. 7. Department of surgery, McGill University Health Center, McGill University, Montréal, Québec, Canada. 8. Department of surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Department of surgery, CHU-Sainte-Justine, Université de Montréal, Montréal, Québec, Canada. 9. McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada.
Abstract
BACKGROUND: There is no systematic evidence review of the long-term results of surgical pulmonary valve replacement (PVR) dedicated to adults with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation. METHODS: Our primary objective was to determine whether PVR reduced long-term mortality in adults with rTOF compared with conservative therapy. Secondary objectives were to determine the postoperative incidence rate of death, the changes in functional capacity and in right ventricular (RV) volumes and ejection fraction after PVR, and the postoperative incidence rate of sustained ventricular arrhythmias. A systematic search of multiple databases for studies was conducted without limits. RESULTS: No eligible randomized controlled trial or cohort study compared outcomes of PVR and conservative therapy in adults with rTOF. We selected 10 cohort studies (total 657 patients) reporting secondary outcomes. After PVR, the pooled incidence rate of death was 1% per year (95% confidence interval [CI] 0-1% per year) and the pooled incidence rate of sustained ventricular arrhythmias was 1% per year (95% CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24). Indexed RV end-diastolic (-61.29 mL/m2, -43.64 to -78.94 mL/m2) and end-systolic (-37.20 mL/m2, -25.58 to -48.82 mL/m2) volumes decreased after PVR, but RV ejection fraction did not change (0.19%, -2.36% to 2.74%). The effect of PVR on RV volumes remained constant regardless of functional status. CONCLUSION: Studies comparing PVR and conservative therapy exclusively in adults with rTOF are lacking. After PVR, the incidence rates of death and ventricular tachycardia are both 1 per 100 patient-years. Pooled analyses demonstrated an improved functional status and a reduction in RV volumes.
BACKGROUND: There is no systematic evidence review of the long-term results of surgical pulmonary valve replacement (PVR) dedicated to adults with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation. METHODS: Our primary objective was to determine whether PVR reduced long-term mortality in adults with rTOF compared with conservative therapy. Secondary objectives were to determine the postoperative incidence rate of death, the changes in functional capacity and in right ventricular (RV) volumes and ejection fraction after PVR, and the postoperative incidence rate of sustained ventricular arrhythmias. A systematic search of multiple databases for studies was conducted without limits. RESULTS: No eligible randomized controlled trial or cohort study compared outcomes of PVR and conservative therapy in adults with rTOF. We selected 10 cohort studies (total 657 patients) reporting secondary outcomes. After PVR, the pooled incidence rate of death was 1% per year (95% confidence interval [CI] 0-1% per year) and the pooled incidence rate of sustained ventricular arrhythmias was 1% per year (95% CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24). Indexed RV end-diastolic (-61.29 mL/m2, -43.64 to -78.94 mL/m2) and end-systolic (-37.20 mL/m2, -25.58 to -48.82 mL/m2) volumes decreased after PVR, but RV ejection fraction did not change (0.19%, -2.36% to 2.74%). The effect of PVR on RV volumes remained constant regardless of functional status. CONCLUSION: Studies comparing PVR and conservative therapy exclusively in adults with rTOF are lacking. After PVR, the incidence rates of death and ventricular tachycardia are both 1 per 100 patient-years. Pooled analyses demonstrated an improved functional status and a reduction in RV volumes.
Authors: Jamie K Harrington; Sunil Ghelani; Nikhil Thatte; Anne Marie Valente; Tal Geva; Julia A Graf; Minmin Lu; Lynn A Sleeper; Andrew J Powell Journal: J Cardiovasc Magn Reson Date: 2021-05-24 Impact factor: 5.364