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Meta-Analysis
. 2017 Aug 4;6(8):e006432.
doi: 10.1161/JAHA.117.006432.

Transcatheter Pulmonary Valve Implantation: A Comprehensive Systematic Review and Meta-Analyses of Observational Studies

Arka Chatterjee  1 , Navkaranbir S Bajaj  2 , William S McMahon  3 , Marc G Cribbs  2   3 , Jeremy S White  4 , Amrita Mukherjee  5 , Mark A Law  3
Affiliations
Meta-Analysis

Transcatheter Pulmonary Valve Implantation: A Comprehensive Systematic Review and Meta-Analyses of Observational Studies

Arka Chatterjee et al. J Am Heart Assoc. .

Abstract

Background: Transcatheter pulmonary valve implantation is approved for the treatment of dysfunctional right ventricle to pulmonary artery conduits. However, the literature is limited because of a small patient population, and it does not reflect changing procedural practice patterns over the last decade.

Methods and results: A comprehensive search of Medline and Scopus databases from inception through August 31, 2016 was conducted using predefined criteria. We included studies reporting transcatheter pulmonary valve implantation in at least 5 patients with a follow-up duration of 6 months or more. In 19 eligible studies, 1044 patients underwent transcatheter pulmonary valve implantation with a pooled follow-up of 2271 person-years. Procedural success rate was 96.2% (95% confidence intervals [CI], 94.6-97.4) with a conduit rupture rate of 4.1% (95% CI, 2.5-6.8) and coronary complication rate of 1.3% (95% CI, 0.7-2.3). Incidence of reintervention was 4.4 per 100 person-years overall (95% CI, 3.0-5.9) with a marked reduction in studies reporting ≥75% prestenting (2.9 per 100 person-years [95% CI, 1.5-4.3] versus 6.5/100 person-years [95% CI, 4.6-8.5]; P<0.01). Pooled endocarditis rate was 1.4 per 100 person-years (95% CI, 0.9-2.0).

Conclusions: Our study provides favorable updated estimates of procedural and follow-up outcomes after transcatheter pulmonary valve implantation. Widespread adoption of prestenting has improved longer-term outcomes in these patients.

Keywords: Melody valve; endocarditis; reintervention; transcatheter pulmonary valve.

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Figures

Figure 1
Figure 1
Flow diagram showing selection of studies for analysis.
Figure 2
Figure 2
Funnel plot of rate of reinterventions using the SE method (95% CI).
Figure 3
Figure 3
Forest plots depicting reintervention rates in the total pooled sample (A)—individual study event rates are noted in the right column (events/follow‐up in person‐years); reintervention rates contrasted among studies with <75% (B) and ≥75% presenting rates (C).
See this image and copyright information in PMC

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