Yi Kang, Wang Dan, Xu Jianguo, Zhang Xin, Wang Wenxin, Gao Jie, Wang Wei, You Tao, Tian Jinhui
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China.
Front Cardiovasc Med. 2022 Jul 13;9:888258. doi: 10.3389/fcvm.2022.888258. eCollection 2022.
To evaluate the efficacy and safety of different surgical strategies to preserve pulmonary valve function. Surgical procedures evaluated include intraoperative balloon pulmonary valvuloplasty (IBPV), pulmonary valve reconstruction, and commissurotomy and pulmonary cusp augmentation (PCA) in patients who underwent a radical operation for Tetralogy of Fallot (ToF).
The five databases searched in the current study included the Cochrane Library, PubMed, China National Knowledge Infrastructure, VIP, and WanFang data. A systematic search for control trials was performed in each database from the start date of each database until December 2021. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies.
A total of 15 retrospective studies with a total number of 1,396 participants were included in this study. In subgroup 1 (IBPV vs. TAP), patients undergoing IBPV had a less degree of regurgitation at 1-2 years after the surgery. The reintervention rate increased in the IBPV group at 5 years. In subgroup 2 (pulmonary valve reconstruction vs. TAP), the degree of regurgitation decreased in the pulmonary valve reconstruction group at 1 month after the surgery. In subgroup 3 (valve-sparing operation vs. TAP), the comparison demonstrated decreased rates for surgical mortality and reintervention at 5-10 years after the surgery.
We proposed that pulmonary valve function in a radical operation for ToF was preserved. IBPV, pulmonary valve reconstruction, and commissurotomy and PCA can be performed during the surgical procedure based on the developmental status and anatomical characteristics of the right ventricular outflow tract (RVOT), pulmonary valve, and pulmonary artery.
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022300987].
评估不同手术策略保留肺动脉瓣功能的疗效和安全性。评估的手术方法包括法洛四联症（ToF）根治术患者的术中球囊肺动脉瓣成形术（IBPV）、肺动脉瓣重建术以及交界切开术和肺动脉瓣叶扩大术（PCA）。
本研究检索的五个数据库包括考克兰图书馆、PubMed、中国知网、维普和万方数据。从每个数据库的起始日期至2021年12月，在每个数据库中进行对照试验的系统检索。采用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。
本研究共纳入15项回顾性研究，总计1396名参与者。在亚组1（IBPV与TAP对比）中，接受IBPV的患者术后1 - 2年反流程度较轻。IBPV组在5年时再次干预率增加。在亚组2（肺动脉瓣重建术与TAP对比）中，肺动脉瓣重建组术后1个月反流程度降低。在亚组3（保留瓣膜手术与TAP对比）中，比较显示术后5 - 10年手术死亡率和再次干预率降低。
我们提出在ToF根治术中肺动脉瓣功能得以保留。可根据右心室流出道（RVOT）、肺动脉瓣和肺动脉的发育状态及解剖特征，在手术过程中实施IBPV、肺动脉瓣重建术以及交界切开术和PCA。
