McRae Marion E, Coleman Bernice, Atz Teresa W, Kelechi Teresa J
1 Medical University of South Carolina, USA.
2 Guerin Family Congenital Heart Program, Cedars-Sinai Medical Center, USA.
Eur J Cardiovasc Nurs. 2017 Aug;16(6):539-553. doi: 10.1177/1474515117696384. Epub 2017 Mar 1.
Individuals with repaired tetralogy of Fallot develop pulmonary regurgitation that may cause symptoms (dyspnea, chest pain, palpitations, fatigue, presyncope, and syncope), impair functional capacity, and may affect health-related quality of life. Surgical pulmonary valve replacement is the gold standard of treatment although transcatheter pulmonary valve replacement is becoming more common. Patients want to know whether less invasive options are as good.
This analysis aimed to examine the differences in surgical versus transcatheter pulmonary valve replacement effects in terms of physiological/biological variables, symptoms, functional status and health-related quality of life.
This quasi-meta-analysis included 85 surgical and 47 transcatheter pulmonary valve replacement studies published between 1995-2016.
In terms of physiological/biological variables, both surgical and transcatheter pulmonary valve replacement improved pulmonary regurgitation and systolic and diastolic right ventricular volume indices but not heart function. In the left heart, only surgical pulmonary valve replacement improved heart function. Only transcatheter pulmonary valve replacement improved left ventricular end-diastolic indices and neither improved endsystolic indices. Only surgery has been demonstrated to decrease QRS duration but there is little evidence of arrhythmia reduction. Symptom change is poorly documented. Functional class improves but exercise capacity generally does not. Some aspects of health-related quality of life improve with surgery and in one small transcatheter pulmonary valve replacement study.
Transcatheter and surgical pulmonary valve replacement compare favorably for heart remodeling. Exercise capacity does not change with either technique. Health-related quality of life improves after surgical pulmonary valve replacement. There are numerous gaps in documentation of changes in arrhythmias and symptoms.
法洛四联症修复术后的个体易出现肺动脉反流，这可能导致症状（呼吸困难、胸痛、心悸、疲劳、先兆晕厥和晕厥），损害功能能力，并可能影响健康相关生活质量。外科肺动脉瓣置换术是治疗的金标准，尽管经导管肺动脉瓣置换术正变得越来越普遍。患者想知道侵入性较小的选择是否同样有效。
本分析旨在研究外科与经导管肺动脉瓣置换术在生理/生物学变量、症状、功能状态和健康相关生活质量方面的效果差异。
这项准荟萃分析纳入了1995年至2016年间发表的85项外科和47项经导管肺动脉瓣置换术研究。
在生理/生物学变量方面，外科和经导管肺动脉瓣置换术均改善了肺动脉反流以及收缩期和舒张期右心室容积指数，但未改善心脏功能。在左心方面，只有外科肺动脉瓣置换术改善了心脏功能。只有经导管肺动脉瓣置换术改善了左心室舒张末期指数，两者均未改善收缩末期指数。只有手术已被证明可缩短QRS时限，但几乎没有证据表明心律失常减少。症状变化记录较少。功能分级有所改善，但运动能力一般未改善。外科手术以及一项小型经导管肺动脉瓣置换术研究显示，健康相关生活质量的某些方面有所改善。
经导管和外科肺动脉瓣置换术在心脏重塑方面效果相当。两种技术均未改变运动能力。外科肺动脉瓣置换术后健康相关生活质量有所改善。心律失常和症状变化的记录存在许多空白。
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