Table_2_Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis.XLSX

BackgroundMeta-analysis of the impact on clinical outcome from transcatheter closure of Fontan fenestration.MethodsCochrane, Embase, MEDLINE, and Open-Gray were searched. Parameters such as changes in oxygen saturation, cavo-pulmonary pressure, maximum heart rate during exercise, exercise duration, and oxygen saturation after fenestration closure were pooled and statistical analysis performed.ResultsAmong 922 publications, 12 retrospective observational studies were included. The included studies involved 610 patients, of which 552 patients (90.5%) had a fenestration. Of those patients, 505 patients (91.5%) underwent attempt at trans-catheter closure. When it could be estimated, the pooled overall mean age at trans-catheter fenestration closure was 6.6 ± 7.4 years, and the mean follow-up time was 34.4 ± 10.7 months. There were 32 minor (6.3%) and 20 major (4.0%) complications during or after trans-catheter Fontan fenestration closure. The forest plots demonstrate that following fenestration closure, there was a significant increase in the mean arterial oxygen saturation of 7.9% (95% CI 6.4–9.4%, p < 0.01). There was also a significant increase in the mean cavo-pulmonary pressure of 1.4 mmHg (95% CI 1.0–1.8 mmHg, p < 0.01) following fenestration closure. The exercise parameters reported in 3 studies also favored closing the fenestration as well, yet the exercise duration increase of 1.7 min (95% CI 0.7–2.8 min, p < 0.01) after fenestration closure is probably clinically insignificant.ConclusionLate closure of a Fontan fenestration has the impact of improving resting oxygen saturation, exercise oxygen saturation, and a modest improvement of exercise duration. These clinical benefits, however, may be at the expense of tolerating slightly higher cavo-pulmonary mean pressures.

背景：对Fontan窗膜闭合对临床结果影响的meta分析。方法：检索了Cochrane、Embase、MEDLINE和Open-Gray数据库。对以下参数进行了汇总和统计分析：氧饱和度变化、心腔-肺动脉压力、运动期间最大心率、运动持续时间和窗膜闭合后的氧饱和度。结果：在922篇出版物中，纳入了12项回顾性观察性研究。纳入的研究涉及610名患者，其中552名患者（90.5%）有窗膜。在这些患者中，505名患者（91.5%）尝试了经导管闭合术。当可以估算时，经导管窗膜闭合术的平均总体年龄为6.6 ± 7.4岁，平均随访时间为34.4 ± 10.7个月。在经导管Fontan窗膜闭合术中或术后发生了32例轻微（6.3%）和20例严重（4.0%）并发症。森林图表明，在窗膜闭合后，平均动脉氧饱和度显著提高了7.9%（95% CI 6.4–9.4%，p < 0.01）。窗膜闭合后，平均心腔-肺动脉压力也显著升高了1.4 mmHg（95% CI 1.0–1.8 mmHg，p < 0.01）。在3项研究中报告的运动参数也有利于闭合窗膜，然而，窗膜闭合后运动持续时间增加的1.7分钟（95% CI 0.7–2.8分钟，p < 0.01）可能从临床角度来看并不显著。结论：Fontan窗膜的晚期闭合可改善静息氧饱和度、运动氧饱和度，并对运动持续时间产生轻微的改善。然而，这些临床益处可能以耐受略高的心腔-肺动脉平均压力为代价。