Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis
ImportanceThe safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent.ObjectiveTo compare the prognosis of single-, two- and three-patch repair for patients with SVAS.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.987522/full |
| _version_ | 1798002386841632768 |
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| author | Lizhi Lv Xinyue Lang Simeng Zhang Cheng Wang Qiang Wang |
| author_facet | Lizhi Lv Xinyue Lang Simeng Zhang Cheng Wang Qiang Wang |
| author_sort | Lizhi Lv |
| collection | DOAJ |
| description | ImportanceThe safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent.ObjectiveTo compare the prognosis of single-, two- and three-patch repair for patients with SVAS.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022.Study selectionStudy reported SVAS patients treated with single-, two- or three-patch repair.Data extraction and synthesisTwo reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed.Main outcomes and measuresOutcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI.ResultsTwenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures.Conclusion and relevanceTwo-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146. |
| first_indexed | 2024-04-11T11:51:21Z |
| format | Article |
| id | doaj.art-c115f0d93362443d8eefbf9d2b3a6fc4 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T11:51:21Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-c115f0d93362443d8eefbf9d2b3a6fc42022-12-22T04:25:23ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.987522987522Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysisLizhi Lv0Xinyue Lang1Simeng Zhang2Cheng Wang3Qiang Wang4Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaMedical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaCenter for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaCenter for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaCenter for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaImportanceThe safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent.ObjectiveTo compare the prognosis of single-, two- and three-patch repair for patients with SVAS.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022.Study selectionStudy reported SVAS patients treated with single-, two- or three-patch repair.Data extraction and synthesisTwo reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed.Main outcomes and measuresOutcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI.ResultsTwenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures.Conclusion and relevanceTwo-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146.https://www.frontiersin.org/articles/10.3389/fcvm.2022.987522/fullsingle-patch repairtwo-patch repairthree-patch repairsupravalvar aortic stenosisnetwork meta-analysis |
| spellingShingle | Lizhi Lv Xinyue Lang Simeng Zhang Cheng Wang Qiang Wang Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis Frontiers in Cardiovascular Medicine single-patch repair two-patch repair three-patch repair supravalvar aortic stenosis network meta-analysis |
| title | Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis |
| title_full | Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis |
| title_fullStr | Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis |
| title_full_unstemmed | Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis |
| title_short | Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis |
| title_sort | assessment of three types of surgical procedures for supravalvar aortic stenosis a systematic review and meta analysis |
| topic | single-patch repair two-patch repair three-patch repair supravalvar aortic stenosis network meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.987522/full |
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