Pulmonary Valve Replacement After Operative Repair of Tetralogy of Fallot
Open accessAbstract
Because the real benefit of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot who develop pulmonary insufficiency remains unclear, it is necessary to analyze the evidence published around the world. We performed a systematic review of studies that reported data about the effect of PVR in patients with repaired tetralogy of Fallot that developed pulmonary insufficiency, until December 2012. The variables chosen to represent the benefit were both right ventricular (RV) and left ventricular measures, QRS duration, and functional class. The principal summary measures were difference in means with 95% confidence interval and p values (considered statistically significant when p < 0.05). The differences in means were combined across studies with the weighted DerSimonian-Laird random effects model. Meta-analysis, sensitivity analysis, and meta-regression were completed with the software Comprehensive Meta-Analysis (version 2, Biostat, Inc., Englewood, New Jersey). Forty-eight studies involving 3,118 patients met the eligibility criteria. The pooled 30-day mortality was 0.87% (47 studies; 27 of 3,100 patients); the pooled 5-year mortality was 2.2% (24 studies; 49 of 2,231 patients); the pooled 5-year re-PVR was 4.9% (15 studies; 88 of 1,798 patients). The results of this meta-analysis demonstrate that after PVR: 1) the RV experiences improvement of its volumes and function; 2) the left ventricle experiences improvement of its function; 3) QRS duration decreases; 4) symptoms improve; 5) pre-operative RV geometry modulates the effect of PVR; and 6) there is important heterogeneity of the effects among the studies, and few publication biases. In conclusion, PVR seems to be a positive approach in the analyzed scenario.
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It is still unclear how best to integrate exercise parameters into management algorithms to support clinical decisions such as pulmonary valve replacement, and a real benefit in exercise capacity and CPET results after PVR has not been demonstrated yet.
“However, it is still unclear how best to integrate these exercise parameters into management algorithms to support clinical decisions, such as pulmonary valve replacement (PVR) [104]. This would be of great interest, especially in asymptomatic patients, where the identification of early sub-clinical dysfunction with objective parameters may represent a boost for PVR. Nevertheless, it should be”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [105]
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- Authors
- Ferraz Cavalcanti, P. E., Sá, M. P. B. O., Santos, C. A., Esmeraldo, I. M., Escobar, R. R. D., Menezes, A. M. D., Azevedo, O. M. D., Vasconcelos Silva, F. P. D., Lins, R. F. D. A., & Lima, R. D. C.
- Affiliations
- Universidade de Pernambuco (BR)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 62
- Issue
- 23
- Pages
- 2227-2243
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W167956446
- Cited by
- 267
- References
- 70
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 12 · 2023: 20 · 2022: 14 · 2021: 23 · 2020: 29 · 2019: 26 · 2018: 31 · 2017: 22 · 2016: 20 · 2015: 20 · 2014: 15 · 2013: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Keywords
- pulmonary valve replacement, repaired tetralogy of Fallot, pulmonary insufficiency, right ventricular function, left ventricular function, QRS duration, functional class, 30-day mortality, reoperation, right ventricular geometry, publication bias
- MeSH terms
- Heart Conduction System, Cardiac Surgical Procedures, Humans, Pulmonary Valve Insufficiency, Stroke Volume, Tetralogy of Fallot, Ventricular Function, Left, Ventricular Function, Right, Treatment Outcome, Heart Valve Prosthesis Implantation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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