Surgical Strategies for Preservation of Pulmonary Valve Function in a Radical Operation for Tetralogy of Fallot: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo 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).Materials and MethodsThe 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.ResultsA 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.ConclusionWe 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.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022300987].

Tetralogy of Fallot: Early Diagnosis and Treatment and its Impact on Survival Rates

“…27 From the analysis of the mentioned facts, the importance of early diagnosis and treatment in individuals with ET was confirmed, and total correction performed in first year of life is the most used approach and therefore considered the best strategy, since it reduces the overload of the right ventricle and consequently promotes the extinction of hypoxia, cyanosis and secondary organ damage, culminating in a reduction in mortality and an increase in survival rate. [28][29][30]…”

Past, present, and future options for right ventricular outflow tract reconstruction

“…This makes the pulmonary valve (PV) the most frequently replaced cardiac valve in congenital heart diseases (1). Nonetheless, any strategy to preserve the pulmonary valve at initial surgery is of course welcome (2), and procedures without preservation of the pulmonary valve have been used as well.…”