体肺分流术和动脉导管支架都可以缓解导管依赖性肺循环。我们旨在比较两种方法的安全性和有效性。
PubMed,EMBASE,我们在2019年12月搜索了CochraneLibrary数据库,以比较导管依赖性肺循环中支架植入术和手术分流术的研究.基线特征包括心室生理和心脏异常。主要结果为住院时间和总死亡率。其他结果包括手术并发症,重症监护病房(ICU)入住,随访时肺动脉生长,和其他指标。使用随机或固定效应模型来总结具有95%置信区间(CI)的平均差异(MD)/风险比(RR)的估计。
总共,纳入了来自6项研究的757例导管依赖性肺循环患者。住院时间的汇总估计(MD,-4.83;95%CI-7.92至-1.74;p<0.05),总死亡率(RR0.44;95%CI0.28-0.70;p<0.05),并发症(RR0.49;95%CI0.30-0.81;p<0.05)和ICU住院时间(MD,-4.00;95%CI-5.96至-2.04;p<0.05)有利于支架组。在单心室(RR0.82;95%CI0.68-0.98;p<0.05)或双心室(RR1.23;95%CI1.07-1.41;p<0.05)患者的比例存在显着差异。支架组和分流组。此外,两组间肺动脉生长无显著差异.
动脉导管支架手术并发症的结局似乎并不差,死亡率,住院和ICU住院,与手术分流术相比,选定患者的肺动脉生长。
CRD42019147672。
Both systemic-pulmonary shunt and arterial duct stent could be the
palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches.
The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs).
In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, - 4.83; 95% CI - 7.92 to - 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28-0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30-0.81; p < 0.05) and ICU stay (MD, - 4.00; 95% CI - 5.96 to - 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68-0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07-1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups.
Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt.
CRD42019147672.