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Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review

BACKGROUND: Dextro-transposition of the great arteries (d-TGA) is the most frequent cyanotic congenital heart pathology in neonates. Surgical correction of this condition is possible using the arterial switch operation (ASO) which was first performed by Jatene in 1975. OBJECTIVES: The aim of this st...

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Autores principales: Morfaw, Frederick, Leenus, Alvin, Mbuagbaw, Lawrence, Anderson, Laura N., Dillenburg, Rejane, Thabane, Lehana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542944/
https://www.ncbi.nlm.nih.gov/pubmed/33028389
http://dx.doi.org/10.1186/s13643-020-01487-3
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author Morfaw, Frederick
Leenus, Alvin
Mbuagbaw, Lawrence
Anderson, Laura N.
Dillenburg, Rejane
Thabane, Lehana
author_facet Morfaw, Frederick
Leenus, Alvin
Mbuagbaw, Lawrence
Anderson, Laura N.
Dillenburg, Rejane
Thabane, Lehana
author_sort Morfaw, Frederick
collection PubMed
description BACKGROUND: Dextro-transposition of the great arteries (d-TGA) is the most frequent cyanotic congenital heart pathology in neonates. Surgical correction of this condition is possible using the arterial switch operation (ASO) which was first performed by Jatene in 1975. OBJECTIVES: The aim of this study was to summarise the evidence on short- (less than 1 year), medium- (1–20 years), and long-term (more than 20 years) outcomes of children with d-TGA treated with the ASO. The primary outcome was survival. Secondary outcomes were freedom from cardiac reoperations, occurrence of aortic insufficiency, pulmonary stenosis, coronary artery anomalies, neuropsychological development problems and quality of life. METHODS: We searched MEDLINE, EMBASE, CINAHL, LILACS, and reference lists of included articles for studies reporting outcomes after ASO for d-TGA. Screening, data extraction and risk of bias assessment were done independently by two reviewers. We pooled data using a random-effects meta-analysis of proportions and, where not possible, outcomes were synthesized narratively. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. MAIN RESULTS: Following ASO for TGA, short-term survival was 92.0% (95% CI 91.0–93.0%; I(2) = 85.8%, 151 studies, 30,186 participants; moderate certainty evidence). Medium-term survival was 90.0% (95% CI 89.0–91.0%; I(2) = 84.3%, 133 studies; 23,686 participants, moderate certainty evidence), while long-term survival was 87.0% (95% CI 80.0–92.0 %; I(2) = 84.5%, 4 studies, 933 participants, very low certainty evidence). Evaluation of the different secondary outcomes also showed satisfactory results in the short, medium and long term. Subgroup analysis suggests slightly higher survival following ASO for TGA in the second surgical era (1998 to 2018) than in the first surgical era (1975 to 1997) in the short and medium term [93.0% (95% CI 92.0–94.0) vs 90.0% (95% CI 89.0–92.0) and 93.0% (95% CI 91.0–94.0) vs 88.0% (87.0–90.0%) respectively] but not in the long term [81.0% (95% CI 76.0–86.0%) vs 89.0% (80.0–95.0%)]. CONCLUSIONS: Pooled data from many sources suggests that the ASO for d-TGA leads to high rates of survival in the short, medium, and long term.
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spelling pubmed-75429442020-10-13 Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review Morfaw, Frederick Leenus, Alvin Mbuagbaw, Lawrence Anderson, Laura N. Dillenburg, Rejane Thabane, Lehana Syst Rev Research BACKGROUND: Dextro-transposition of the great arteries (d-TGA) is the most frequent cyanotic congenital heart pathology in neonates. Surgical correction of this condition is possible using the arterial switch operation (ASO) which was first performed by Jatene in 1975. OBJECTIVES: The aim of this study was to summarise the evidence on short- (less than 1 year), medium- (1–20 years), and long-term (more than 20 years) outcomes of children with d-TGA treated with the ASO. The primary outcome was survival. Secondary outcomes were freedom from cardiac reoperations, occurrence of aortic insufficiency, pulmonary stenosis, coronary artery anomalies, neuropsychological development problems and quality of life. METHODS: We searched MEDLINE, EMBASE, CINAHL, LILACS, and reference lists of included articles for studies reporting outcomes after ASO for d-TGA. Screening, data extraction and risk of bias assessment were done independently by two reviewers. We pooled data using a random-effects meta-analysis of proportions and, where not possible, outcomes were synthesized narratively. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. MAIN RESULTS: Following ASO for TGA, short-term survival was 92.0% (95% CI 91.0–93.0%; I(2) = 85.8%, 151 studies, 30,186 participants; moderate certainty evidence). Medium-term survival was 90.0% (95% CI 89.0–91.0%; I(2) = 84.3%, 133 studies; 23,686 participants, moderate certainty evidence), while long-term survival was 87.0% (95% CI 80.0–92.0 %; I(2) = 84.5%, 4 studies, 933 participants, very low certainty evidence). Evaluation of the different secondary outcomes also showed satisfactory results in the short, medium and long term. Subgroup analysis suggests slightly higher survival following ASO for TGA in the second surgical era (1998 to 2018) than in the first surgical era (1975 to 1997) in the short and medium term [93.0% (95% CI 92.0–94.0) vs 90.0% (95% CI 89.0–92.0) and 93.0% (95% CI 91.0–94.0) vs 88.0% (87.0–90.0%) respectively] but not in the long term [81.0% (95% CI 76.0–86.0%) vs 89.0% (80.0–95.0%)]. CONCLUSIONS: Pooled data from many sources suggests that the ASO for d-TGA leads to high rates of survival in the short, medium, and long term. BioMed Central 2020-10-07 /pmc/articles/PMC7542944/ /pubmed/33028389 http://dx.doi.org/10.1186/s13643-020-01487-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Morfaw, Frederick
Leenus, Alvin
Mbuagbaw, Lawrence
Anderson, Laura N.
Dillenburg, Rejane
Thabane, Lehana
Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
title Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
title_full Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
title_fullStr Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
title_full_unstemmed Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
title_short Outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
title_sort outcomes after corrective surgery for congenital dextro-transposition of the arteries using the arterial switch technique: a scoping systematic review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542944/
https://www.ncbi.nlm.nih.gov/pubmed/33028389
http://dx.doi.org/10.1186/s13643-020-01487-3
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