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Meta-Analysis
. 2022 Jul 9;35(2):ivac162.
doi: 10.1093/icvts/ivac162.

Risk factors for postoperative pulmonary venous obstruction after surgical repair of total anomalous pulmonary venous connection: a systemic review and meta-analysis

Han Zhang  1 , Guocheng Shi  1 , Huiwen Chen  1
Affiliations
Meta-Analysis

Risk factors for postoperative pulmonary venous obstruction after surgical repair of total anomalous pulmonary venous connection: a systemic review and meta-analysis

Han Zhang et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: A meta-analysis was performed to investigate the risk factors for postoperative pulmonary venous obstruction (PVO) after surgical repair of total anomalous pulmonary venous connection (TAPVC).

Methods: Data bases including PubMed, Embase, Web of Science and Cochrane Library were searched systematically. The goal was to discuss the risk factors for postoperative PVO after TAPVC. Publications were screened by 2 authors independently for criteria inclusion, methodological quality assessment and data extraction. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist were obtained to assess the quality of the studies. Data were pooled by the random effect model or the fixed effect model according to the heterogeneity test.

Results: A total of 16 studies (2,385 participants) were included in the meta-analysis. All included studies were retrospective studies. Six potential risk factors were pooled, 5 of which were significantly associated with postoperative PVO. Patients with preoperative PVO were more likely to suffer from postoperative PVO [odds ratio (OR)=5.27, 95% confidence interval (CI) = (2.75, 10.11), P < 0.01]. Compared with a sutureless procedure, the conventional operative procedure was associated with postoperative PVO [OR = 1.80, 95% CI=(1.20, 2.71), P < 0.01]. A mixed type TAPVC plays a critical role in postoperative PVO [OR = 3.78, 95% CI=(1.08, 13.18), P = 0.04]. Inverse variance analysis showed that longer cardiopulmonary bypass time [hazard ratio (HR)=1.01, 95% CI=(1.01, 1.02), P < 0.00001] and aortic cross-clamp time [HR = 1.01, 95% CI=(1.01, 1.02), P < 0.01] were significantly associated with postoperative PVO. Heterotaxy [OR = 1.18, 95% CI = 0.13, 10.45, P = 0.88] was not statistically significant as a risk factor for postoperative PVO.

Conclusions: This meta-analysis may provide a perspective on the risk factors for postoperative PVO after TAPVC, thus leading to more studies predicting postoperative PVO after TAPVC with our findings.

Keywords: PVO; TAPVC; postoperative; risk factors.

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Figures

Figure 1:
Figure 1:
Study selection flow chart.
Figure 2:
Figure 2:
Forest plot of meta-analysis of heterotaxy. CI: confidence interval; M-H: Mantel-Haenszel; Post-op: postoperative; PVS: pulmonary vein stenosis.
Figure 3:
Figure 3:
Forest plot of meta-analysis of intrinsic or preoperative pulmonary venous obstruction. CI: confidence interval; M-H: Mantel-Haenszel; Post-op: postoperative; PVS: pulmonary vein stenosis.
Figure 4:
Figure 4:
Forest plot of meta-analysis of conventional technique versus sutureless technique. CI: confidence interval; M-H: Mantel-Haenszel.
Figure 5:
Figure 5:
Funnel plot of publication bias of studies of conventional technique versus sutureless technique. OR: odds ratio; SE: standard error.
Figure 6:
Figure 6:
Forest plot of meta-analysis of mixed type of total anomalous pulmonary venous connection. CI: confidence interval; M-H: Mantel-Haenszel.
Figure 7:
Figure 7:
Forest plot of meta-analysis of cardiopulmonary bypass time. CI: confidence interval; IV: ; SE: standard error.
Figure 8:
Figure 8:
Forest plot of meta-analysis of aortic cross-clamp time. CI: confidence interval; IV: ; SE: standard error.
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