Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Pediatric and Congenital Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Unit of Biostatistics, University of Padova Medical School, Padova, Italy.
Eur J Cardiothorac Surg. 2022 Nov 3;62(6). doi: 10.1093/ejcts/ezac535.
A conclusive interpretation of the role of ventricular dominance in outcomes after Fontan palliation has not been formulated yet. We conducted a systematic review and meta-analysis of scientific literature to give an insight into the impact of ventricular morphology in single-ventricle palliation, focusing on its influence on survival, morbidities, ventricular performance and functional capacity.
A systematic review of PubMed, Web of Science and Scopus databases was performed. A random-effect meta-analysis was conducted, and survival data were reconstructed using the published Kaplan-Meier survival curves.
Twenty-seven studies were selected, for a total of 4529 left-dominant versus 4844 right-dominant patients. Estimated survival at 1, 5, 10, 20 and 30 years of follow-up was 0.99 [95% confidence interval (CI) = 0.98-0.99], 0.95 [95% CI = 0.94-0.96], 0.92 [95% CI = 0.91-0.93], 0.86 [95% CI = 0.84-0.88] and 0.68 [95% CI = 0.65-0.83] for left-dominant patients and 0.94 [95% CI = 0.93-0.95], 0.89 [95% CI = 0.88-0.9], 0.85 [95% CI = 0.83-0.87], 0.69 [95% CI = 0.63-0.75] and 0.59 [95% CI = 0.5-0.69] for right-dominant patients, respectively. Survival was statistically lower for right-dominant patients (P < 0.001), with an hazard ratio for the mortality of 2.38 (2.03-2.80); also, they displayed significantly longer hospital stay, worse ventricular function, larger ventricular volumes and a higher incidence of moderate or severe atrioventricular valve regurgitation when compared to left-dominant patients.
According to our meta-analysis, the morphology of the dominant ventricle has a significant impact on outcomes after Fontan palliation. Right-dominant patients experience an inferior long-term survival when the anatomical right ventricle is included in the systemic circulation.
目前尚未明确心室优势在 Fontan 姑息术后结局中的作用。我们进行了系统评价和荟萃分析，以深入了解单心室姑息治疗中心室形态的影响，重点关注其对生存率、发病率、心室功能和功能能力的影响。
对 PubMed、Web of Science 和 Scopus 数据库进行了系统检索。采用随机效应荟萃分析，并使用已发表的 Kaplan-Meier 生存曲线重建生存数据。
共纳入 27 项研究，总计左优势组 4529 例，右优势组 4844 例。1、5、10、20 和 30 年随访时的估计生存率分别为 0.99[95%可信区间（CI）=0.98-0.99]、0.95[95% CI=0.94-0.96]、0.92[95% CI=0.91-0.93]、0.86[95% CI=0.84-0.88]和 0.68[95% CI=0.65-0.83]为左优势组，0.94[95% CI=0.93-0.95]、0.89[95% CI=0.88-0.9]、0.85[95% CI=0.83-0.87]、0.69[95% CI=0.63-0.75]和 0.59[95% CI=0.5-0.69]为右优势组。右优势组患者的生存率明显低于左优势组（P<0.001），其死亡率的风险比为 2.38（2.03-2.80）；与左优势组相比，右优势组患者的住院时间更长，心室功能更差，心室容积更大，中重度房室瓣反流的发生率更高。
根据我们的荟萃分析，优势心室的形态对 Fontan 姑息术后的结局有显著影响。当解剖右心室纳入体循环时，右优势患者的长期生存率较低。
