The efficacy of the treat-repair-treat strategy for severe pulmonary arterial hypertension associated with congenital heart disease: a meta-analysis
Abstract
Abstract Background This meta-analysis was conducted to evaluate the efficacy of the treat-repair-treat (TRT) strategy in the treatment of severe pulmonary arterial hypertension with congenital heart disease (PAH-CHD). Methods PubMed, EMBASE, Cochrane and Web of Science online databases were searched by two independent investigators for studies that used the TRT strategy for PAH-CHD, and the retrieved studies were reviewed by a third investigator. The main outcomes were pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), 6-minute walk distance (6MWD), and transcutaneous oxygen saturation (SpO2). The changes were compared between follow-up and baseline. Stata version 14.0 was used for data analysis. A random-effects model was selected for meta-analysis. Subgroup analysis and meta-regression were used to find the source of heterogeneity. Results A total of 335 patients from 9 single-arm studies were included. Meta-analysis showed significant reductions in PAP and PVR and improvements in 6MWD and SpO2(PAP: SMD -2.73 95% CI -2.97, − 2.50p = < 0.001; PVR: SMD -1.27 95% CI -1.53, − 1.02p = < 0.001; 6MWD: SMD 1.88 95% CI 1.49, 2.27p = < 0.001; SpO2: SMD 3.72 95% CI 3.13, 4.32p = < 0.001). Subgroup analysis showed that younger patients had better efficacy, and the change in SpO2was an indication for patient selection. The combined mortality rate was 5% at follow-up. Conclusions In this meta-analysis, we demonstrated that the TRT strategy may have positive effects…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 335 participants or records.
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