Mathias Possner1, Stephanie Y Tseng1, Fares Alahdab2, Jouke P Bokma3, Adam M Lubert1, Paul Khairy4, M Hassan Murad2, Walid Ben Ali5, Larry J Prokop6, Richard J Czosek1, Gruschen R Veldtman7, Tarek Alsaied8. 1. Heart Institute, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA. 2. Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA. 3. Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands. 4. Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada. 5. Division of Cardiac Surgery, CHU-ME Sainte Justine and the Montréal Heart Institute, Université de Montréal, Montréal, Canada. 6. Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA. 7. Heart Institute, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA; Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 8. Heart Institute, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA. Electronic address: Tarek.Alsaied@cchmc.org.
Abstract
BACKGROUND: Patients with repaired tetralogy of Fallot (rTOF) have increased risk for mortality, sudden cardiac death, and ventricular tachycardia (VT). The aim of this systematic review and meta-analysis is to offer an updated analysis of risk factors following significant changes in surgical and perioperative management. METHODS: A meta-analysis based on the published literature between 2008 and 2018 was conducted. Endpoints were VT, cardiac mortality/VT, and all-cause mortality/VT. Studies with ≥100 patients and ≥10 events were included. RESULTS: Fifteen studies including 7218 patients (average age 27.5 years) were analyzed. Risk factors for VT included older age (per 1 year, odds ratio [OR]: 1.039; 95% confidence interval [CI]: 1.025-1.053), older age at corrective surgery (per 1 year, OR: 1.034; CI: 1.017-1.051), previous palliative shunt (OR: 3.063; CI: 1.525-6.151), number of thoracotomies (OR: 1.416; CI: 1.249-1.604), longer QRS duration (per 1 ms, OR: 1.031; CI: 1.008-1.055), and at least moderate right-ventricular dysfunction (OR: 2.160; CI_ 1.311-3.560). Additional risk factors for cardiac death/VT were previous ventriculotomy (OR: 2.269; CI: 1.226-4.198), lower left-ventricular ejection fraction (per 1%, OR: 1.049; CI: 1.029-1.071), and higher right-ventricular end diastolic volume (per 1 mL/m2, OR: 1.009; CI: 1.002-1.016). Supraventricular tachycardia/atrial fibrillation was an additional risk factor for all-cause mortality/VT (OR: 1.939; CI: 1.088-3.457). CONCLUSIONS: The study highlights the importance of preservation of biventricular systolic function on late outcomes. Ventricular function appears to have a greater impact on outcomes than the severity of pulmonary regurgitation alone in this patient population.
BACKGROUND:Patients with repaired tetralogy of Fallot (rTOF) have increased risk for mortality, sudden cardiac death, and ventricular tachycardia (VT). The aim of this systematic review and meta-analysis is to offer an updated analysis of risk factors following significant changes in surgical and perioperative management. METHODS: A meta-analysis based on the published literature between 2008 and 2018 was conducted. Endpoints were VT, cardiac mortality/VT, and all-cause mortality/VT. Studies with ≥100 patients and ≥10 events were included. RESULTS: Fifteen studies including 7218 patients (average age 27.5 years) were analyzed. Risk factors for VT included older age (per 1 year, odds ratio [OR]: 1.039; 95% confidence interval [CI]: 1.025-1.053), older age at corrective surgery (per 1 year, OR: 1.034; CI: 1.017-1.051), previous palliative shunt (OR: 3.063; CI: 1.525-6.151), number of thoracotomies (OR: 1.416; CI: 1.249-1.604), longer QRS duration (per 1 ms, OR: 1.031; CI: 1.008-1.055), and at least moderate right-ventricular dysfunction (OR: 2.160; CI_ 1.311-3.560). Additional risk factors for cardiac death/VT were previous ventriculotomy (OR: 2.269; CI: 1.226-4.198), lower left-ventricular ejection fraction (per 1%, OR: 1.049; CI: 1.029-1.071), and higher right-ventricular end diastolic volume (per 1 mL/m2, OR: 1.009; CI: 1.002-1.016). Supraventricular tachycardia/atrial fibrillation was an additional risk factor for all-cause mortality/VT (OR: 1.939; CI: 1.088-3.457). CONCLUSIONS: The study highlights the importance of preservation of biventricular systolic function on late outcomes. Ventricular function appears to have a greater impact on outcomes than the severity of pulmonary regurgitation alone in this patient population.
Authors: Christos Zormpas; Ann Sophie Silber-Peest; Jörg Eiringhaus; Henrike A K Hillmann; Stephan Hohmann; Johanna Müller-Leisse; Mechthild Westhoff-Bleck; Christian Veltmann; David Duncker Journal: ESC Heart Fail Date: 2021-02-03