Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128, Padua, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
Pediatr Cardiol. 2024 Dec;45(8):1702-1712. doi: 10.1007/s00246-023-03256-0. Epub 2023 Aug 9.
To date, evidence supporting the efficacy of tricuspid valve (TV) repair in interrupting the progression of systemic right ventricular (RV) adverse remodeling in hypoplastic left heart syndrome (HLHS) is conflicting. We conducted a systematic review and meta-analysis of scientific literature to assess the impact of TV repair in effectively modifying the prognosis of patients with HLHS. We conducted a systematic review of PubMed, Web of Science, and Scopus databases. A random-effect meta-analysis was performed and transplant-free survival, freedom from TV regurgitation, and TV reoperation data were reconstructed using the published Kaplan-Meier curves. Nine studies were included, comprising 203 HLHS patients undergoing TV repair and 323 HLHS controls. The estimated transplant-free survival at 1, 5, and 10 years of follow-up was 75.5% [95% confidence interval (CI) = 67.6-84.3%], 63.6% [95% CI = 54.6-73.9%], and 61.9% [95% CI = 52.7-72.6%], respectively. Transplant-free survival was comparable to HLHS peers without TV regurgitation (p = 0.59). Five-year freedom from recurrence of TV regurgitation and freedom from TV reoperation was 57% [95% CI = 46.7-69.7%] and 63.6% [95% CI = 54.5-74.3%], respectively. Younger age and TV repair at the time of Norwood operation increased the risk of TV regurgitation recurrence and the need for TV reoperation. Our meta-analysis supports the efficacy of TV repair in favorably modifying the prognosis of patients with HLHS and TV regurgitation, reestablishing a medium-term transplant-free survival which is comparable to HLHS peers. However, durability of surgery and long-term fate of TV and RV performance are still unclear.
迄今为止，关于三尖瓣（TV）修复术能否中断左心发育不全综合征（HLHS）患者的系统性右心室（RV）不良重塑进展的证据尚无定论。我们对科学文献进行了系统回顾和荟萃分析，以评估 TV 修复术对 HLHS 患者预后的影响。
我们对 PubMed、Web of Science 和 Scopus 数据库进行了系统回顾。使用已发表的 Kaplan-Meier 曲线对 TV 修复术的无移植生存率、无 TV 反流率和 TV 再次手术数据进行了随机效应荟萃分析。
纳入了 9 项研究，共纳入 203 例接受 TV 修复术的 HLHS 患者和 323 例 HLHS 对照组。1、5 和 10 年的无移植生存率估计值分别为 75.5%（95%置信区间 [CI] = 67.6%-84.3%）、63.6%（95% CI = 54.6%-73.9%）和 61.9%（95% CI = 52.7%-72.6%）。无 TV 反流的 HLHS 患者的无移植生存率与 TV 修复术组相当（p = 0.59）。5 年时 TV 反流复发和 TV 再次手术的无复发率分别为 57%（95% CI = 46.7%-69.7%）和 63.6%（95% CI = 54.5%-74.3%）。年龄较小和在 Norwood 手术时进行 TV 修复增加了 TV 反流复发和 TV 再次手术的风险。
我们的荟萃分析支持 TV 修复术能改善 HLHS 患者和 TV 反流患者的预后，重建与 HLHS 患者相当的中期无移植生存率。然而，手术的耐久性和 TV 及 RV 功能的长期结局仍不清楚。
