Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
Evidence-Based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, People's Republic of China.
BMC Cardiovasc Disord. 2021 Jan 6;21(1):9. doi: 10.1186/s12872-020-01817-2.
Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches.
The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs).
In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, - 4.83; 95% CI - 7.92 to - 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28-0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30-0.81; p < 0.05) and ICU stay (MD, - 4.00; 95% CI - 5.96 to - 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68-0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07-1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups.
Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt.
CRD42019147672.
体肺分流术和动脉导管支架均可作为依赖动脉导管循环的姑息疗法。我们旨在比较两种方法的安全性和有效性。
通过 2019 年 12 月对 PubMed、EMBASE 和 Cochrane 图书馆数据库的检索，比较了依赖动脉导管循环的支架植入术和外科分流术。基本特征包括心室生理学和心脏异常。主要结果是住院时间和总死亡率。其他结果包括手术并发症、重症监护病房（ICU）停留时间、随访时肺动脉生长情况以及其他指标。使用随机或固定效应模型汇总均数差（MD）/风险比（RR）的估计值，置信区间（CI）为 95%。
共有来自 6 项研究的 757 例依赖动脉导管循环的患者纳入研究。汇总估计的住院时间（MD，-4.83；95%CI-7.92 至-1.74；p<0.05）、总死亡率（RR 0.44；95%CI 0.28-0.70；p<0.05）、并发症（RR 0.49；95%CI 0.30-0.81；p<0.05）和 ICU 停留时间（MD，-4.00；95%CI-5.96 至-2.04；p<0.05）均有利于支架组。支架组与分流组患者中患有单心室（RR 0.82；95%CI 0.68-0.98；p<0.05）或双心室（RR 1.23；95%CI 1.07-1.41；p<0.05）的比例存在显著差异。此外，两组之间肺动脉生长无显著差异。
与外科分流术相比，在选择的患者中，动脉导管支架似乎具有相似的手术并发症、死亡率、住院时间和 ICU 停留时间及肺动脉生长的结局。
CRD42019147672。
