Clinical Outcomes of Transcatheter Versus Surgical Pulmonary Valve Replacement: a Meta-analysis

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2020 Feb 8

PMID 32030252

Citations 8

Authors

Ying Zhou

Tixiusi Xiong

Peng Bai

Chong Chu

Nianguo Dong

Affiliations

Soon will be listed here.

Abstract

Background: Transcatheter pulmonary valve replacement (TPVR) has currently been a well-established alternative operation method to surgical pulmonary valve replacement (SPVR) in patients with pulmonary valve dysfunction in the form of stenosis and/or regurgitation. We conducted a meta-analysis to evaluate the main clinical outcomes after TPVR and SPVR.

Methods: We systematically searched the references of relevant literatures from PubMed and the Cochrane Library published between January 2000 and December 2018 and followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study.

Results: Eleven studies with 4,364 patients were included in the study. Compared with SPVR, TPVR results in a significant decreased in-hospital mortality [odds ratio (OR): 0.18; 95% confidence interval (CI): 0.03-0.98] and mortality at the longest reported follow-up time point (OR: 0.43; 95% CI: 0.22-0.87), though 30-day mortality (OR: 0.38; 95% CI: 0.11-1.33) has no significant difference between groups. Days of hospital stay [(mean difference (MD): -4.38; 95% CI: -6.24--2.53] is shorter with TPVR than SPVR. Besides, rates of 30-day readmission (OR: 0.67; 95% CI: 0.50-0.91) and recurrent pulmonary regurgitation (OR: 0.17; 95% CI: 0.07-0.42) are lower with TPVR, whereas postprocedural infective endocarditis (IE) (OR: 4.56; 95% CI: 2.03-10.26) are higher with TPVR. SPVR carries a decreased risk of re-operation (OR: 2.19; 95% CI: 0.62-7.76) though without statistically significance.

Conclusions: In conclusion, TPVR is associated with a significantly decreased mortality, a shorter length of hospital-stay, a lower rate of 30-day readmission and recurrent pulmonary regurgitation as compared to SPVR throughout the follow-up duration, whereas SPVR results in a significantly lower rate of postprocedural IE than TPVR. In addition, SPVR carries a decreased risk of re-operation with statistically insignificance.

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Occurrence and Outcome of Infective Endocarditis after Surgical Compared to Transcatheter Pulmonary Valve Implantation in Congenital Heart Disease.

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Slouha E, Johnson L, Thirunavukarasu A, Al-Geizi H, Clunes L, Kollias T Cureus. 2023; 15(10):e48022.

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References

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Hascoet S, Acar P, Boudjemline Y . Transcatheter pulmonary valvulation: current indications and available devices. Arch Cardiovasc Dis. 2014; 107(11):625-34. DOI: 10.1016/j.acvd.2014.07.048. View

Bearl D, Fleming G . Utilizing Hybrid Techniques to Maximize Clinical Outcomes in Congenital Heart Disease. Curr Cardiol Rep. 2017; 19(8):72. DOI: 10.1007/s11886-017-0878-2. View

Agrawal H, AlKashkari W, Kenny D . Evolution of hybrid interventions for congenital heart disease. Expert Rev Cardiovasc Ther. 2017; 15(4):257-266. DOI: 10.1080/14779072.2017.1307733. View

OByrne M, Gillespie M, Shinohara R, Dori Y, Rome J, Glatz A . Cost comparison of Transcatheter and Operative Pulmonary Valve Replacement (from the Pediatric Health Information Systems Database). Am J Cardiol. 2015; 117(1):121-6. PMC: 4690775. DOI: 10.1016/j.amjcard.2015.10.011. View

AlKashkari W, Alsubei A, Hijazi Z . Transcatheter Pulmonary Valve Replacement: Current State of Art. Curr Cardiol Rep. 2018; 20(4):27. DOI: 10.1007/s11886-018-0966-y. View

Deb S, Austin P, Tu J, Ko D, Mazer C, Kiss A . A Review of Propensity-Score Methods and Their Use in Cardiovascular Research. Can J Cardiol. 2015; 32(2):259-65. DOI: 10.1016/j.cjca.2015.05.015. View

Caughron H, Kim D, Kamioka N, Lerakis S, Yousef A, Maini A . Repeat Pulmonary Valve Replacement: Similar Intermediate-Term Outcomes With Surgical and Transcatheter Procedures. JACC Cardiovasc Interv. 2018; 11(24):2495-2503. DOI: 10.1016/j.jcin.2018.07.042. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339:b2535. PMC: 2714657. DOI: 10.1136/bmj.b2535. View

10.

Warnes C, Liberthson R, Danielson G, Dore A, Harris L, Hoffman J . Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol. 2001; 37(5):1170-5. DOI: 10.1016/s0735-1097(01)01272-4. View

11.

Sosnowski C, Matella T, Fogg L, Ilbawi M, Nagaraj H, Kavinsky C . Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR. Catheter Cardiovasc Interv. 2016; 88(5):804-810. DOI: 10.1002/ccd.26620. View

12.

Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D . Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet. 2000; 356(9239):1403-5. DOI: 10.1016/S0140-6736(00)02844-0. View

13.

Warnes C, Williams R, Bashore T, Child J, Connolly H, Dearani J . ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop.... Circulation. 2008; 118(23):2395-451. DOI: 10.1161/CIRCULATIONAHA.108.190811. View

14.

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

15.

Malekzadeh-Milani S, Ladouceur M, Iserin L, Bonnet D, Boudjemline Y . Incidence and outcomes of right-sided endocarditis in patients with congenital heart disease after surgical or transcatheter pulmonary valve implantation. J Thorac Cardiovasc Surg. 2014; 148(5):2253-9. DOI: 10.1016/j.jtcvs.2014.07.097. View

16.

Kheiwa A, Divanji P, Mahadevan V . Transcatheter pulmonary valve implantation: will it replace surgical pulmonary valve replacement?. Expert Rev Cardiovasc Ther. 2018; 16(3):197-207. DOI: 10.1080/14779072.2018.1435273. View

17.

Sharma V, Griffiths E, Eckhauser A, Gray R, Martin M, Zhang C . Pulmonary Valve Replacement: A Single-Institution Comparison of Surgical and Transcatheter Valves. Ann Thorac Surg. 2018; 106(3):807-813. DOI: 10.1016/j.athoracsur.2018.04.002. View

18.

Alassas K, Mohty D, Clavel M, Husain A, Hijji T, Aljoufan M . Transcatheter versus surgical valve replacement for a failed pulmonary homograft in the Ross population. J Thorac Cardiovasc Surg. 2018; 155(4):1434-1444. DOI: 10.1016/j.jtcvs.2017.10.141. View

19.

Geva T . Indications and timing of pulmonary valve replacement after tetralogy of Fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006; :11-22. DOI: 10.1053/j.pcsu.2006.02.009. View

20.

Wadia S, Lluri G, Aboulhosn J, Shivkumar K, Reemtsen B, Laks H . Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement. Heart. 2018; 104(21):1791-1796. DOI: 10.1136/heartjnl-2017-312769. View