Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia; Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, North Sumatera, Indonesia.
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Int J Cardiol. 2023 Jul 1;382:106-111. doi: 10.1016/j.ijcard.2023.03.050. Epub 2023 Mar 29.
Critical aortic stenosis that appears in mid-gestation tends to develop to growth retardation of left ventricle, known as hypoplastic left heart syndrome (HLHS). Despite better clinical management of HLHS, the morbidity and mortality rates of univentricular circulation patients remain high. In this paper, we sought to perform a systematic review and meta-analysis to know the outcomes of fetal aortic valvuloplasty in critical aortic stenosis patients.
This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. A systematic search on fetal aortic valvuloplasty procedure for critical aortic stenosis was performed through PubMed, Scopus, EBSCOhost, ProQuest, and Google Scholar. The primary endpoint of each group was overall mortality. We used R software (version 4.1.3) to estimate the overall proportion of each outcome using random-effects model of proportional meta-analysis.
A total of 389 fetal subjects from 10 cohort studies were included in this systematic review and meta-analysis. Fetal aortic valvuloplasty (FAV) was successfully performed in 84% of patients. It revealed a successful conversion to biventricular circulation rate of 33% with a mortality rate of 20%. Bradycardia and pleural effusion requiring treatment were two most common fetal complications, whereas maternal complication reported was only placental abruption in one patient.
FAV has a high technical success rate with the ability to achieve biventricular circulation and a low rate of procedure-related mortality if carried out by experienced operators.
中孕期出现的严重主动脉瓣狭窄往往会导致左心室生长发育迟缓，即左心发育不良综合征（HLHS）。尽管 HLHS 的临床管理有所改善，但单心室循环患者的发病率和死亡率仍然很高。在本文中，我们旨在进行系统评价和荟萃分析，以了解严重主动脉瓣狭窄患者行胎儿主动脉瓣成形术的结局。
本系统评价和荟萃分析根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。通过 PubMed、Scopus、EBSCOhost、ProQuest 和 Google Scholar 对胎儿主动脉瓣成形术治疗严重主动脉瓣狭窄的程序进行了系统检索。每个组的主要终点是总体死亡率。我们使用 R 软件（版本 4.1.3）使用比例荟萃分析的随机效应模型来估计每个结局的总体比例。
本系统评价和荟萃分析共纳入了 10 项队列研究的 389 名胎儿受试者。在 84%的患者中成功进行了胎儿主动脉瓣成形术（FAV）。它显示出 33%的成功率转化为双心室循环，死亡率为 20%。心动过缓和需要治疗的胸腔积液是最常见的两种胎儿并发症，而仅在一名患者中报告了一种母体并发症即胎盘早剥。
如果由经验丰富的操作人员进行操作，FAV 具有较高的技术成功率，能够实现双心室循环，且与该操作相关的死亡率较低。
