Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies
Background: Tetralogy of Fallot (ToF) is a cardiac malformation that accounts for up to 1/10 of all congenital diseases. Although surgical repair serves as a treatment of choice, it cannot be performed unless weight and anatomical key factors are favorable. The stenting of the right ventricular out...
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| Format: | Article |
| Language: | English |
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Tehran University of Medical Sciences
2021-10-01
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| Series: | Journal of Tehran University Heart Center |
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| Online Access: | https://jthc.tums.ac.ir/index.php/jthc/article/view/1432 |
| _version_ | 1818975007025397760 |
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| author | Andrea Laurentius Lowilius Wiyono Anita Dominique Subali Sisca Natalia Siagian |
| author_facet | Andrea Laurentius Lowilius Wiyono Anita Dominique Subali Sisca Natalia Siagian |
| author_sort | Andrea Laurentius |
| collection | DOAJ |
| description |
Background: Tetralogy of Fallot (ToF) is a cardiac malformation that accounts for up to 1/10 of all congenital diseases. Although surgical repair serves as a treatment of choice, it cannot be performed unless weight and anatomical key factors are favorable. The stenting of the right ventricular outflow tract (RVOT) has become an alternative palliative procedure for ToF as an option to alleviate infundibular obstruction with minimal invasion.
Methods: A literature search was conducted through 7 databases, followed by the screening and independent assessment of 6 final studies, using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was then conducted using inverse variance analysis, and cumulative data were presented with forest and funnel plots.
Results: Studied patients were referred for RVOT stenting due to the marked obstruction of the pulmonary blood flow, a low birth weight, or a small pulmonary artery size. The analysis revealed a significant increase in O2 saturation (mean difference [MD=18%; 13–23.78). The same trend was observed concerning an increase in the Nakata index (MD=54.59; 10.05–99.14), the right pulmonary artery diameter (MD=2.28; 1.20–3.36), and the left pulmonary artery diameter (MD=1.77; 0.22–3.32). Several complications were found, including tricuspid regurgitation and frequent premature beats.
Conclusion: RVOT stenting is considered a feasible palliative treatment for ToF, with its high effectiveness in improving patients’ condition, especially their pulmonary flow. While complications are scarce, several conditions should be noted, particularly for fatal complications. Finally, this study has limitations as catheterization details in studies and diverse infants’ conditions may have caused potential bias.
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| first_indexed | 2024-12-20T15:49:06Z |
| format | Article |
| id | doaj.art-cfa70e2076a24296b009ca155ca9a63b |
| institution | Directory Open Access Journal |
| issn | 1735-8620 2008-2371 |
| language | English |
| last_indexed | 2024-12-20T15:49:06Z |
| publishDate | 2021-10-01 |
| publisher | Tehran University of Medical Sciences |
| record_format | Article |
| series | Journal of Tehran University Heart Center |
| spelling | doaj.art-cfa70e2076a24296b009ca155ca9a63b2022-12-21T19:34:46ZengTehran University of Medical SciencesJournal of Tehran University Heart Center1735-86202008-23712021-10-0116410.18502/jthc.v16i4.8599Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational StudiesAndrea Laurentius0Lowilius Wiyono1Anita Dominique Subali2Sisca Natalia Siagian3Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.Faculty of Medicine, Universitas Brawijaya, East Java, Indonesia.National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Background: Tetralogy of Fallot (ToF) is a cardiac malformation that accounts for up to 1/10 of all congenital diseases. Although surgical repair serves as a treatment of choice, it cannot be performed unless weight and anatomical key factors are favorable. The stenting of the right ventricular outflow tract (RVOT) has become an alternative palliative procedure for ToF as an option to alleviate infundibular obstruction with minimal invasion. Methods: A literature search was conducted through 7 databases, followed by the screening and independent assessment of 6 final studies, using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was then conducted using inverse variance analysis, and cumulative data were presented with forest and funnel plots. Results: Studied patients were referred for RVOT stenting due to the marked obstruction of the pulmonary blood flow, a low birth weight, or a small pulmonary artery size. The analysis revealed a significant increase in O2 saturation (mean difference [MD=18%; 13–23.78). The same trend was observed concerning an increase in the Nakata index (MD=54.59; 10.05–99.14), the right pulmonary artery diameter (MD=2.28; 1.20–3.36), and the left pulmonary artery diameter (MD=1.77; 0.22–3.32). Several complications were found, including tricuspid regurgitation and frequent premature beats. Conclusion: RVOT stenting is considered a feasible palliative treatment for ToF, with its high effectiveness in improving patients’ condition, especially their pulmonary flow. While complications are scarce, several conditions should be noted, particularly for fatal complications. Finally, this study has limitations as catheterization details in studies and diverse infants’ conditions may have caused potential bias. https://jthc.tums.ac.ir/index.php/jthc/article/view/1432Tetralogy of FallotPalliative care; SafetyPostoperative complicationsVentricular outflow obstruction |
| spellingShingle | Andrea Laurentius Lowilius Wiyono Anita Dominique Subali Sisca Natalia Siagian Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies Journal of Tehran University Heart Center Tetralogy of Fallot Palliative care; Safety Postoperative complications Ventricular outflow obstruction |
| title | Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies |
| title_full | Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies |
| title_fullStr | Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies |
| title_full_unstemmed | Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies |
| title_short | Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-analysis of Observational Studies |
| title_sort | evaluation of right ventricular outflow tract stenting as palliative treatment in severely cyanotic tetralogy of fallot a systematic review and meta analysis of observational studies |
| topic | Tetralogy of Fallot Palliative care; Safety Postoperative complications Ventricular outflow obstruction |
| url | https://jthc.tums.ac.ir/index.php/jthc/article/view/1432 |
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