Comparison of the fenestrated and non-fenestrated Fontan procedures: A meta-analysis.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
entrez:
24
7
2019
pubmed:
25
7
2019
medline:
2
8
2019
Statut:
ppublish
Résumé
The benefits of fenestration for patients undergoing Fontan procedure seem controversial at early and late postoperative stages. We aimed to compare the outcomes between the fenestrated and non-fenestrated Fontan procedures. Studies comparing the fenestrated and non-fenestrated Fontan procedures were identified by searching the PubMed, EMBASE, and Cochrane Library databases until July 2018. The assessed variables included postoperative oxygen saturation (SaO2), pulmonary artery pressure, mortality, cardiopulmonary bypass (CPB) time, ventilation time, intensive care unit stay, hospital stay, chest tube duration, protein-losing enteropathy, arrhythmia, and other follow-up outcomes including reintervention, stroke/thrombosis, and peak oxygen consumption. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis stratified by early and late outcomes was performed. A total of 1929 Fontan patients from 14 studies were included. The early postoperative SaO2 was lower with fenestration than without fenestration (MD -2.52, 95% CI -4.16 to -0.87, P <.05); however, the late postoperative SaO2 showed no difference between the 2 approaches. The CPB time was shorter without fenestration than with fenestration (MD 10.72, 95% CI 2.54-18.9, P <.05); however, the incidence of arrhythmia was lower with fenestration than without fenestration (OR 0.43, 95% CI 0.25-0.75, P <.05). Other variables showed no significant differences between the 2 approaches in Fontan patients. Fenestration appears to result in a lower incidence of arrhythmia but with a longer CPB time and lower early SaO2. Other outcomes are comparable between the 2 approaches.
Sections du résumé
BACKGROUND
BACKGROUND
The benefits of fenestration for patients undergoing Fontan procedure seem controversial at early and late postoperative stages.
OBJECTIVE
OBJECTIVE
We aimed to compare the outcomes between the fenestrated and non-fenestrated Fontan procedures.
METHODS
METHODS
Studies comparing the fenestrated and non-fenestrated Fontan procedures were identified by searching the PubMed, EMBASE, and Cochrane Library databases until July 2018. The assessed variables included postoperative oxygen saturation (SaO2), pulmonary artery pressure, mortality, cardiopulmonary bypass (CPB) time, ventilation time, intensive care unit stay, hospital stay, chest tube duration, protein-losing enteropathy, arrhythmia, and other follow-up outcomes including reintervention, stroke/thrombosis, and peak oxygen consumption. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis stratified by early and late outcomes was performed.
RESULTS
RESULTS
A total of 1929 Fontan patients from 14 studies were included. The early postoperative SaO2 was lower with fenestration than without fenestration (MD -2.52, 95% CI -4.16 to -0.87, P <.05); however, the late postoperative SaO2 showed no difference between the 2 approaches. The CPB time was shorter without fenestration than with fenestration (MD 10.72, 95% CI 2.54-18.9, P <.05); however, the incidence of arrhythmia was lower with fenestration than without fenestration (OR 0.43, 95% CI 0.25-0.75, P <.05). Other variables showed no significant differences between the 2 approaches in Fontan patients.
CONCLUSION
CONCLUSIONS
Fenestration appears to result in a lower incidence of arrhythmia but with a longer CPB time and lower early SaO2. Other outcomes are comparable between the 2 approaches.
Identifiants
pubmed: 31335738
doi: 10.1097/MD.0000000000016554
pii: 00005792-201907190-00073
pmc: PMC6709047
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16554Références
Eur J Cardiothorac Surg. 2006 Dec;30(6):923-9
pubmed: 17074498
Contemp Clin Trials. 2007 Feb;28(2):105-14
pubmed: 16807131
BMJ. 2015 Jan 02;350:g7647
pubmed: 25555855
J Epidemiol Community Health. 1998 Jun;52(6):377-84
pubmed: 9764259
Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):50-4; discussion 54
pubmed: 19351688
Circulation. 1992 Dec;86(6):1762-9
pubmed: 1451248
Circulation. 2002 Jan 15;105(2):207-12
pubmed: 11790702
Pediatr Cardiol. 2017 Apr;38(4):643-649
pubmed: 28116475
Ann Thorac Surg. 2014 Mar;97(3):924-31; discussion 930-1
pubmed: 24495416
Ann Thorac Surg. 2000 Jun;69(6):1900-6
pubmed: 10892944
Circulation. 1990 Nov;82(5):1866-7
pubmed: 2225386
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
Thorax. 1971 May;26(3):240-8
pubmed: 5089489
J Am Coll Cardiol. 1999 Aug;34(2):539-44
pubmed: 10440170
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14(1):11-8
pubmed: 21444043
Chin Med J (Engl). 2009 Oct 5;122(19):2335-8
pubmed: 20079136
J Am Coll Cardiol. 2011 Jun 14;57(24):2437-43
pubmed: 21658565
Med Sci Monit. 2018 May 26;24:3506-3513
pubmed: 29802801
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
J Thorac Cardiovasc Surg. 1990 Aug;100(2):228-32
pubmed: 2143549
Eur J Cardiothorac Surg. 2001 Jun;19(6):785-92
pubmed: 11404131
J Thorac Cardiovasc Surg. 1982 Mar;83(3):427-36
pubmed: 7062754
Cardiol Young. 2006 Feb;16(1):54-60
pubmed: 16454878
J Thorac Cardiovasc Surg. 2010 Jul;140(1):129-36
pubmed: 20620378
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
Pediatr Cardiol. 2014 Mar;35(3):514-20
pubmed: 24150685
Congenit Heart Dis. 2017 Jul;12(4):399-402
pubmed: 28618202
Ann Thorac Surg. 2007 Sep;84(3):894-9
pubmed: 17720396
Arq Bras Cardiol. 2002 Feb;78(2):162-6
pubmed: 11887191
Circulation. 1990 Nov;82(5):1681-9
pubmed: 2225370