META Analysis Of Percutaneous Balloon Pulmonic Valvuloplasty And Surgery In Pulmonary Stenosis

Objective: Pulmonary stenosis (PS) is one of the most common congenital heart diseases in children. There are two methods to cure it: one is Percutaneous balloon pulmonic valvuloplasty (PBPV), another one is surgical repair. To systematically evaluate the clinic effectiveness and safety of PBPV and surgery in pulmonary stenosis, so that suitable treatment would be selected partly based on this study.Methods: PubMed Database, OVID Database, EBSCO Database, Chinese Biomedicine database(CBMdisc), VIP Database for Chinese Technical Periodicals, digital journal of WanFang Data and China national Knowledge Internet(CNKI) were searched to locate relevant controlled trials. According to including and excluding criteria, articles were evaluated (Shekelle PG, et al). Data extraction and assessment of methodology quality were performed independently by two reviewers, including general situation just as age, weight, preoperative pressure gradient(PG), hospitalization days and expenses; analytical target just as success rate, survival rate, postoperative PG, pulmonary regurgitation rate,tricuspid regurgitation rate, follow-up PG and complication rate. Meta-analysis was performed by Revman 5.0 software. Effects were expressed as mean difference (MD) and 95% confidence interval (CI) for continuous data while risk ratio (RR) and 95%CI for dichotomous data.Results: Five papers (including 523 patients) were identified. All of them are non-randomized control trial(IIa).The age, weight, preoperative PG and expenses were similar in two groups, and the hospitalization days in surgical group was longer than PBPV group. The success rate in PBPV group (96.2%) was similar to surgical group (100%), P=0.46. The survival rate in two groups was 100%. The postoperative PG in PBPV group(20.96±14.92) was similar to surgical group(18.24±11.24), P=0.08. The pulmonic regurgitation rate in PBPV group(35.4%) was lower than surgical group(71.1%), P=0.007. The Tricuspid regurgitation rate in PBPV group(9.24%) was lower than surgical group(23.6%), P=0.01. The follow-up PG in PBPV group(17.94±14.08) was similar to surgical group(13.90±9.82), P=0.11. The complication rate in PBPV group( 11.4%) was similar to surgical group(28.3%), P=0.14.Conclusion: The two groups are safe and effective. PBPV has the advantages of minimal trauma, recovering fast, low incidence of complication, but it is selective and the success rate needs to be increase. By strictly standardize the indication and operation the operation failure rate would be lower. Surgical repair has the higher success rate and is suitable for more patients, but it bring about more complications. If the patient with pulmonary stenosis is suitable, PBPV will be the first choice.