What is the clinical evidence from this study?

Study design: Systematic Review. Population: Tetralogy of Fallot requiring late pulmonary valve replacement. Intervention: Mechanical valve prostheses vs. Biological valves.

What does this research mean for the field?

Mechanical valve prostheses are a relatively safe alternative to biological valves for pulmonary valve replacement late after tetralogy of Fallot repair when appropriate anticoagulation is maintained. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 30, 2014Interactive Cardiovascular and Thoracic Surgery

Is there a role for mechanical valve prostheses in pulmonary valve replacement late after tetralogy of Fallot repair?: Table 1:

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Key result

Mechanical pulmonary valves match biological valves for safety late post-ToF repair with 0 thromboembolic events.

Why the study?

The role and safety of mechanical valve prostheses in pulmonary valve replacement late after tetralogy of Fallot repair remain controversial and understudied with limited patient numbers and variable anticoagulation regimens.

What is the role of mechanical valve prostheses in pulmonary valve replacement late after tetralogy of Fallot (TOF) repair?

Population

Patients requiring pulmonary valve replacement late after repair of tetralogy of Fallot

Comparison

Mechanical valve prostheses with anticoagulation versus biological valves

Design

Best evidence topic systematic review of more than 30 papers with 9 best evidence studies

Authors

JAJonathan R. AbbasUniversity of Manchester JHJ. Andreas HoschtitzkyRoyal Brompton & Harefield NHS Foundation Trust

Discussion

Member takes

Implication

May support mechanical pulmonary prostheses in anticoagulated post-TOF patients; extends sparse evidence on pulmonary-position durability.

Study Design

Type

Systematic Review

Structured PICO

What is the role of mechanical valve prostheses in pulmonary valve replacement late after tetralogy of Fallot (TOF) repair?

Population

Patients requiring pulmonary valve replacement late after repair of tetralogy of Fallot (TOF)

Intervention

Mechanical valve prostheses in the pulmonary position with anticoagulation

Comparator

Biological valves

Outcome

Safety and efficacy including early mortality, valvar thrombosis, thromboembolic events, and major haemorrhagic complicationssafety

Mechanical pulmonary valve prostheses are a safe alternative to biological valves late after tetralogy of Fallot repair when patients adhere to appropriate anticoagulation.

Limitations

Literature is very limited in terms of patient numbers
Significant variability in the regimes of anticoagulation
Use in patients with concomitant pulmonary arterial stenoses may prevent future percutaneous interventions of the pulmonary arterial tree
Inconsistent follow-up of echocardiographic, valve-related and warfarin-related complications
Significant variability in anticoagulation regimes
Less advisable in patients with concomitant pulmonary arterial stenoses as it prevents future percutaneous interventions

Cite This Study

Abbas et al. (2014) conducted a systematic review in Tetralogy of Fallot requiring late pulmonary valve replacement. Mechanical valve prostheses vs. Biological valves was evaluated. Mechanical pulmonary prostheses appear to be a safe alternative to biological valves late after tetralogy of Fallot repair, with 3 reviewed papers recording no thromboembolic events during follow-up.

synapsesocial.com/papers/6ab08ba27e979cb029ebf460 https://doi.org/10.1093/icvts/ivt541

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Implication

May support mechanical pulmonary prostheses in anticoagulated post-TOF patients; extends sparse evidence on pulmonary-position durability.

Is there a role for mechanical valve prostheses in pulmonary valve replacement late after tetralogy of Fallot repair?: Table 1:

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Is there a role for mechanical valve prostheses in pulmonary valve replacement late after tetralogy of Fallot repair?: Table 1:

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider