Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a ...Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases where stenting is either challenging or unsuccessful.展开更多
Background:The surgical outcomes of tetralogy of Fallot(TOF)have evolved dramatically and have resulted in lower mortality rate.Currently,the many cardiac centers have a trend to early single-stage complete repair mor...Background:The surgical outcomes of tetralogy of Fallot(TOF)have evolved dramatically and have resulted in lower mortality rate.Currently,the many cardiac centers have a trend to early single-stage complete repair more than a staged repair.However,the patients who have an early primary repair were required transannular patch augmentation of a pulmonary valve frequently.This effect has been developed a chronic pulmonary insufficiency may lead to right ventricular dilation,dysfunction.In this era,the aim of treatment of TOF is attempted to preserve pulmonary valve annulus for prevent right ventricular dysfunction in the future.The systemic to pulmonary artery shunt is a palliative procedure or known as staged repair for symptomatic patients with TOF.The modified Blalock-Taussig shunt(mBTS)is the most useful systemic to pulmonary shunt and perform as an initial procedure before complete repair.The mBTS can provide increase pulmonary blood flow as well as improve oxygenation and also promote pulmonary artery(PA)growth.However,the effect of this procedure to promote growth of a pulmonary valve annulus is still debate.Objectives:To compare a growth of pulmonary valve annulus between after staged repair and primary repair in patients with TOF(without pulmonary atresia).Methods:A retrospective case-control study,review of patients with TOF underwent total repair at our hospitals from January 2005 and December 2017 was performed,a total number of 112 patients underwent TOF repair.Twenty-nine patients(26%)underwent a staged repair(mBTS group)and 83(74%)underwent total repair only or primary repair(PR group).We evaluated diameter of pulmonary valve annulus by using echocardiography at the time of first diagnosis and before complete repair on both groups.Results:The age of diagnosis of mBTS group were younger than PR group(p=0.011).Therefore,pulmonary valve annuls were smaller in mBTS group.(Z-score,−2.93±1.42 vs.−1.89±0.97;p=0.001).However,the growth potential of pulmonary valve annulus was increase more than PR group significantly(Z-score,−1.46±1.02 vs.−2.11±1.19;p=0.009)Even though a patent ductus arteriosus was found commonly in PR group(p=0.018).Conclusions:Our results suggest the systemic to pulmonary shunt or mBTS can promote growth of pulmonary valve annulus in patients with TOF.展开更多
The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of ductus arteriosus stent(DAS)compared with surgical systemic-pulmonary artery shunt(SPS)in patients with...The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of ductus arteriosus stent(DAS)compared with surgical systemic-pulmonary artery shunt(SPS)in patients with ductal-dependent pulmonary blood flow.A literature search was conducted in PubMed,Embase,and the Cochrane Library databases from their inception to December 2020.Two reviewers independently screened the articles,evaluated the quality of the articles,and collected the data.Meta-analyses were conducted using fixed and random effects models.We used the I-square(I2)test to examine heterogeneity and the funnel plot Egger’s test was used to test for publication bias.We analyzed nine studies including 842 patients were included in the present study(DAS:n=295;SPS:n=547).There was a benefit in favor of DAS group for medium-term mortality(RR,0.63;95%CI,[0.40,0.99];P=0.91,I^(2)=0%).DAS group demonstrated a reduced risk for complications compared with SPS(RR,0.46;95%CI,[0.29,0.72];P=0.78,I^(2)=0%).There was an increased risk for unplanned reintervention for DAS(RR,1.77;95%CI,[1.42,2.20];P=0.61,I2=0%).DAS demonstrated shorter mean intensive care unit length of stay(MD,–5.12;95%CI,[–7.33,–2.91];P=0.005,I^(2)=76%).There was also demonstrated higher postprocedure oxygen saturation for SPS over DAS(MD,1.78;95% CI,[0.92,2.64];P=0.46,I2=0%).There was no difference between the two groups in terms of mortality within 30 days,Nakata Index,and hospital length of stay.Conclusions:In terms of initial palliative surgical in the ductal-dependent pulmonary blood flow,DAS demonstrated a lower risk of medium-term mortality,lower risk of complications,higher risk of unplanned reintervention,shorter ICU length of stay,and higher postprocedure oxygen saturation compared with SPS.展开更多
目的比较不伴主、肺动脉侧枝(MAPCAs)的肺动脉闭锁伴室间隔缺损(PA/VSD)患者接受右心室至肺动脉(RV-PA)管道连接或改良体-肺动脉分流术(mBT)术后血气及血流动力学指标改变,以明确两种术式对氧供需平衡的影响。方法2006年7月至2007年10月...目的比较不伴主、肺动脉侧枝(MAPCAs)的肺动脉闭锁伴室间隔缺损(PA/VSD)患者接受右心室至肺动脉(RV-PA)管道连接或改良体-肺动脉分流术(mBT)术后血气及血流动力学指标改变,以明确两种术式对氧供需平衡的影响。方法2006年7月至2007年10月,对38例不伴MAPCAs的PA/VSD患者根据手术方式不同分为两组:RV-PA组(n=25)和mBT组(n=13)。比较围术期死亡率,术后48h内的血气及血流动力学指标,包括心率、血压、动脉血氧饱和度、混合静脉血氧饱和度、氧剩余参数和正性肌力药物评分等的改变。结果术后RV-PA组死亡率(4.0%)与mBT组(7.7%)比较差异无统计学意义(P>0.05)。随访33例,随访时间6～18个月。11例患者(其中mBT组4例、RV-PA组7例)在术后9～18个月接受了根治手术治疗,术后死亡1例,死于肺血管阻力过高,右心衰竭。术后24h、48h时RV-PA组和mBT组混合静脉血氧饱和度均分别高于本组术后6h(P<0.01),术后6h、24h和48 h RV-PA组收缩压均低于mBT组(P=0.048,0.043,0.045);平均动脉压均高于mBT组(P=0.048,0.046,0.049);舒张压均高于mBT组(P=0.038,0.034,0.040);正性肌力药物评分均低于mBT组(P=0.035,0.032,0.047)。结论RV-PA管道连接与mBT两种姑息手术,虽然术后血压和正性肌力药物评分有显著差异,但体循环氧输送基本相当,术后6h两组患者血流动力学状态达最低水平。展开更多
文摘Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases where stenting is either challenging or unsuccessful.
基金This research project is supported by Naresuan University fund.
文摘Background:The surgical outcomes of tetralogy of Fallot(TOF)have evolved dramatically and have resulted in lower mortality rate.Currently,the many cardiac centers have a trend to early single-stage complete repair more than a staged repair.However,the patients who have an early primary repair were required transannular patch augmentation of a pulmonary valve frequently.This effect has been developed a chronic pulmonary insufficiency may lead to right ventricular dilation,dysfunction.In this era,the aim of treatment of TOF is attempted to preserve pulmonary valve annulus for prevent right ventricular dysfunction in the future.The systemic to pulmonary artery shunt is a palliative procedure or known as staged repair for symptomatic patients with TOF.The modified Blalock-Taussig shunt(mBTS)is the most useful systemic to pulmonary shunt and perform as an initial procedure before complete repair.The mBTS can provide increase pulmonary blood flow as well as improve oxygenation and also promote pulmonary artery(PA)growth.However,the effect of this procedure to promote growth of a pulmonary valve annulus is still debate.Objectives:To compare a growth of pulmonary valve annulus between after staged repair and primary repair in patients with TOF(without pulmonary atresia).Methods:A retrospective case-control study,review of patients with TOF underwent total repair at our hospitals from January 2005 and December 2017 was performed,a total number of 112 patients underwent TOF repair.Twenty-nine patients(26%)underwent a staged repair(mBTS group)and 83(74%)underwent total repair only or primary repair(PR group).We evaluated diameter of pulmonary valve annulus by using echocardiography at the time of first diagnosis and before complete repair on both groups.Results:The age of diagnosis of mBTS group were younger than PR group(p=0.011).Therefore,pulmonary valve annuls were smaller in mBTS group.(Z-score,−2.93±1.42 vs.−1.89±0.97;p=0.001).However,the growth potential of pulmonary valve annulus was increase more than PR group significantly(Z-score,−1.46±1.02 vs.−2.11±1.19;p=0.009)Even though a patent ductus arteriosus was found commonly in PR group(p=0.018).Conclusions:Our results suggest the systemic to pulmonary shunt or mBTS can promote growth of pulmonary valve annulus in patients with TOF.
文摘The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of ductus arteriosus stent(DAS)compared with surgical systemic-pulmonary artery shunt(SPS)in patients with ductal-dependent pulmonary blood flow.A literature search was conducted in PubMed,Embase,and the Cochrane Library databases from their inception to December 2020.Two reviewers independently screened the articles,evaluated the quality of the articles,and collected the data.Meta-analyses were conducted using fixed and random effects models.We used the I-square(I2)test to examine heterogeneity and the funnel plot Egger’s test was used to test for publication bias.We analyzed nine studies including 842 patients were included in the present study(DAS:n=295;SPS:n=547).There was a benefit in favor of DAS group for medium-term mortality(RR,0.63;95%CI,[0.40,0.99];P=0.91,I^(2)=0%).DAS group demonstrated a reduced risk for complications compared with SPS(RR,0.46;95%CI,[0.29,0.72];P=0.78,I^(2)=0%).There was an increased risk for unplanned reintervention for DAS(RR,1.77;95%CI,[1.42,2.20];P=0.61,I2=0%).DAS demonstrated shorter mean intensive care unit length of stay(MD,–5.12;95%CI,[–7.33,–2.91];P=0.005,I^(2)=76%).There was also demonstrated higher postprocedure oxygen saturation for SPS over DAS(MD,1.78;95% CI,[0.92,2.64];P=0.46,I2=0%).There was no difference between the two groups in terms of mortality within 30 days,Nakata Index,and hospital length of stay.Conclusions:In terms of initial palliative surgical in the ductal-dependent pulmonary blood flow,DAS demonstrated a lower risk of medium-term mortality,lower risk of complications,higher risk of unplanned reintervention,shorter ICU length of stay,and higher postprocedure oxygen saturation compared with SPS.
文摘目的比较不伴主、肺动脉侧枝(MAPCAs)的肺动脉闭锁伴室间隔缺损(PA/VSD)患者接受右心室至肺动脉(RV-PA)管道连接或改良体-肺动脉分流术(mBT)术后血气及血流动力学指标改变,以明确两种术式对氧供需平衡的影响。方法2006年7月至2007年10月,对38例不伴MAPCAs的PA/VSD患者根据手术方式不同分为两组:RV-PA组(n=25)和mBT组(n=13)。比较围术期死亡率,术后48h内的血气及血流动力学指标,包括心率、血压、动脉血氧饱和度、混合静脉血氧饱和度、氧剩余参数和正性肌力药物评分等的改变。结果术后RV-PA组死亡率(4.0%)与mBT组(7.7%)比较差异无统计学意义(P>0.05)。随访33例,随访时间6～18个月。11例患者(其中mBT组4例、RV-PA组7例)在术后9～18个月接受了根治手术治疗,术后死亡1例,死于肺血管阻力过高,右心衰竭。术后24h、48h时RV-PA组和mBT组混合静脉血氧饱和度均分别高于本组术后6h(P<0.01),术后6h、24h和48 h RV-PA组收缩压均低于mBT组(P=0.048,0.043,0.045);平均动脉压均高于mBT组(P=0.048,0.046,0.049);舒张压均高于mBT组(P=0.038,0.034,0.040);正性肌力药物评分均低于mBT组(P=0.035,0.032,0.047)。结论RV-PA管道连接与mBT两种姑息手术,虽然术后血压和正性肌力药物评分有显著差异,但体循环氧输送基本相当,术后6h两组患者血流动力学状态达最低水平。
