Heart Institute, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA.
Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.
Can J Cardiol. 2020 Nov;36(11):1815-1825. doi: 10.1016/j.cjca.2020.01.023. Epub 2020 Feb 4.
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.
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.
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/m, 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).
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.
修复法洛四联症（rTOF）的患者死亡率、心源性猝死和室性心动过速（VT）风险增加。本系统回顾和荟萃分析的目的是提供在手术和围手术期管理发生重大变化后的风险因素的最新分析。
基于 2008 年至 2018 年发表的文献进行荟萃分析。终点为 VT、心源性死亡/VT 和全因死亡/VT。纳入至少 100 例患者和≥10 例事件的研究。
分析了 15 项研究共 7218 例患者（平均年龄 27.5 岁）。VT 的危险因素包括年龄较大（每增加 1 岁，比值比 [OR]：1.039；95%置信区间 [CI]：1.025-1.053）、矫正手术时年龄较大（每增加 1 岁，OR：1.034；CI：1.017-1.051）、先前姑息性分流术（OR：3.063；CI：1.525-6.151）、开胸术次数（OR：1.416；CI：1.249-1.604）、QRS 时限较长（每增加 1ms，OR：1.031；CI：1.008-1.055）和至少中度右心室功能障碍（OR：2.160；CI：1.311-3.560）。心源性死亡/VT 的其他危险因素包括先前心室切开术（OR：2.269；CI：1.226-4.198）、左心室射血分数较低（每降低 1%，OR：1.049；CI：1.029-1.071）和右心室舒张末期容积较高（每增加 1mL/m，OR：1.009；CI：1.002-1.016）。室上性心动过速/心房颤动是全因死亡/VT 的另一个危险因素（OR：1.939；CI：1.088-3.457）。
该研究强调了保护双心室收缩功能对晚期结果的重要性。在该患者人群中，心室功能似乎比单纯肺动脉瓣反流的严重程度对结果有更大的影响。
