Meta-Analysis of Pulmonary Valve Replacement After Operative Repair of Tetralogy of Fallot

The present meta-analysis aimed to determine the outcomes and effect on right ventricular (RV) function of surgical pulmonary valve replacement (PVR) in patients after repair of tetralogy of Fallot. The reported outcomes of surgical PVR in children and adults after tetralogy of Fallot repair were from relatively small observational studies. The PubMed database was searched from its inception to April 2009. Observational studies reporting on the following outcomes measures after surgical PVR were reviewed: early and late all-cause mortalities, the redo-PVR rate, and changes in the indexed RV volumes, ejection fraction, and QRS duration after PVR. Of the 305 citations screened, 15 met the criteria and were analyzed. The pooled early mortality rate (n = 595) was 2.1% (95% confidence interval [CI] 1.1% to 4.0%). The late mortality rate was 0.5%/patient-year (95% CI 0.2% to 0.8%/patient-year), and the redo-PVR rate was 1.9%/patient-year (95% CI 1.3% to 2.5%/patient-year). Data on RV volumes and ejection fractions were available from 5 studies (n = 141). The pooled mean difference in the indexed RV end-diastolic and end-systolic volume was −63 ml/m2 (95% CI −55 to −72) and −37 ml/m2 (95% CI −30 to −45), respectively. No significant changes in the pooled mean difference of the RV ejection fraction (95% CI −1% to 3%) or QRS duration (95% CI −10 to 1 ms) were observed. In conclusion, surgical PVR in patients after tetralogy of Fallot repair has been associated with low early and late mortality and significant decreases in RV volumes but no changes in the RV ejection fraction or QRS duration.