The New Era in the Surgical Management of Tetrology of Fallot in Pediatric Patients: A Meta-Analysis

Abstract

Background: Provided the high incidence of Tetrology of Fallot, a compelling need for different surgical management techniques have been raised. Thus, a new era was developed in this field that gave favorable results, however a debate still exists on the optimal technique to relieve the Right Ventricular Outflow Tract Obstruction that could lead to less mortality and morbidity, hence it was necessary to analyze data that compare these different techniques. Moreover, there is a controversy between cardiac surgeons about the best technique to correct the RVOT in infants with Tetrology of fallot and so this study was done to compare between two frequent techniques according to their mortality and morbidity. Aim of the work: Assess the outcome after surgical repair of tetrology of fallot in pediatric patients comparing between transannular patch and valve sparing techniques. Methods: The present study was planned in accordance with current guidelines for performing comprehensive systemic reviews and meta-analysis including the PRISMA (Preferred Reporting Items For Systemic Review Meta-Analysis), MOOSE (Meta-analysis of Observational Studies in Epidemiology) and guidelines for randomized and nonrandomized studies. In this study a meta-analysis was done to compare between the two most common techniques (21-32) that are used to relieve the RVOT that are Transannular patch VS Valve Sparing Repair the variable chosen include: Mortality the Indexed Right Ventricular Volumes, QRS duration, incidence of pulmonary regurgitation, Right ventricular Ejection Fraction, Left Ventricular Ejection Fraction and incidence of Reoperation. The principal summary measures were difference in means with 95% confidence interval and p value (to be of significant if p < 0.005 ) . The difference in means were combined across studies with MedCalc© version 15.8 (MedCalc© Software bvba, Ostend, Belgium. Results: A total of 72 citation were identified of which 20 studies were potentially relevant and retrieved in full text only 12 studies fulfilled the eligibility criteria There was 74% of patients had a TAP and 26% of patients had VSR. Mortality was 291 among patients with patch repair and 104 among valve sparing repair. Reoperation was detected in 7 patients with TAP VS 6 patients in VSR. Occurrence of PR was detected in 14 patients in TAP VS 12 patients in VSR. The study detected favorable measures in Indexed right ventricular volumes, RV ejection fraction and QRS duration in patients with VSR than those with TAP. This study detected that both group of patients had approximately equal results of LV ejection fraction. Conclusion: Our results reflected that Valve Sparing Repair for pediatric patients has better outcome in Mortality to relieve pulmonary stenosis, occurrence of pulmonary valve regurgitation as well as a less harmful effect on the right ventricular ejection fraction, better Indexed right ventricular volume and QRS duration than using transannular patching technique. Both transannular patching and valve sparing repair have approximately the same effect on the left ventricular ejection fraction that may need further studies.