Mid-to-long Term Outcomes After Pulmonary Valve Replacement: A Systematic Review And Meta-analysis
Xu Wang, Wouter Bakhuis, Kevin M. Veen, Ad J.J.C Bogers, Jonathan R.G. Etnel, Carlijn C.E.M. van der Ven, Jolien W. Roos-Hesselink, Eleni-Rosalina Andrinopoulou, Johanna J.M. Takkenberg.
Erasmus Medical Center, Rotterdam, Netherlands.
Objective: Pulmonary valve replacement (PVR) is performed for congenital pulmonary valve disease and during a Ross procedure for aortic valve disease. This study aimed to provide an overview of outcomes after PVR in different settings. Methods: The literature was systematically searched for articles published between January 2000 and September 2020 reporting on clinical/echocardiographic outcomes after surgical PVR. A random-effects model was used to pool outcome variables, and late outcomes were visualised by pooled Kaplan-Meier curves.Results: One hundred and ninety-five articles were included, comprising 32,513 patients (mean age: 22.32±11.45 years; female: 31.34%) and 205,686 patient-years. In total, 59 studies focused on Ross related PVR (n=12,775), 99 on Non-Ross related PVR (n=11,467), 73 on PVR with homograft (n=12,673) and 63 on PVR with xenograft (n=5,588), respectively. Aortic valve disease (Ross procedure; 47.1%) and Tetralogy of Fallot (26.6%) were two main aetiologies. The pooled estimates of early and late mortality, annualised rate of re-intervention and endocarditis were 3.38% (95% CI: 2.92-3.91), 0.70%/y (95% CI: 0.61-0.81), 3.23%/y (95% CI: 2.71-3.86) and 0.37%/y (95% CI: 0.29-0.46), respectively. PVR with homograft had lower annualised risk of re-intervention (2.38%/y vs. 4.29%/y, p=0.009) and endocarditis (0.20%/y vs. 0.81%/y, p<0.001) compared to xenograft. Pooled Kaplan-Meier curves suggested that a homograft was associated with lower probability of endocarditis(Figure1). Ross related PVR had lower risk of late mortality(0.53%/y vs. 0.84%/y, p=0.016), re-intervention (1.30%/y vs. 4.44%/y, p<0.001) and endocarditis(0.20%/y vs. 0.44%/y, p<0.001) compared to non-Ross related PVR.Conclusions: This study shows that patients undergoing surgery of PVR have an acceptable early and late mortality and morbidity. However, outcomes vary as patients' characteristics change. Xenograft performs worse than homograft on the risk of endocarditis. However, further research is required to investigate whether the difference is due to graft itself or other confounders.
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