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 fenestration经导管闭合对临床结局影响进行的荟萃分析。
方法：检索了Cochrane、Embase、MEDLINE和Open-Gray数据库。汇总了以下参数的变化：氧饱和度、心房-肺动脉压力、运动时的最大心率、运动持续时间以及fenestration闭合后的氧饱和度，并进行了统计分析。
结果：在922篇出版物中，纳入了12项回顾性观察性研究。这些研究涉及610名患者，其中552名患者（90.5%）存在fenestration。在这些患者中，505名患者（91.5%）尝试了经导管闭合手术。当可估算时，经导管fenestration闭合的平均年龄为6.6 ± 7.4岁，平均随访时间为34.4 ± 10.7个月。在经导管Fontan fenestration闭合期间或之后，发生了32例轻微并发症（6.3%）和20例严重并发症（4.0%）。森林图显示，在fenestration闭合后，平均动脉氧饱和度显著升高了7.9%（95% CI 6.4–9.4%，p < 0.01）。同时，在fenestration闭合后，平均心房-肺动脉压力也显著升高了1.4 mmHg（95% CI 1.0–1.8 mmHg，p < 0.01）。3项研究中报告的运动参数也倾向于闭合fenestration，但fenestration闭合后运动持续时间增加了1.7 min（95% CI 0.7–2.8 min，p < 0.01），这种增加在临床上可能并不显著。
结论：Fontan fenestration的延迟闭合可改善休息时氧饱和度、运动时氧饱和度，并适度延长运动持续时间。然而，这些临床益处可能以略微升高的心房-肺动脉平均压力为代价。