Comparison of staged repair versus single-stage complete repair for pulmonary atresia with ventricular septal defect: A systematic review and meta-analysis.

AIMS: To evaluate comparative outcomes of the repair of pulmonary atresia with ventricular septal defect (PAVSD), done as staged repair (SR) or single-stage complete repair (CR).

METHODS: A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov, and ScienceDirect for studies comparing SR versus CR for treatment of PAVSD. Total mortality rate, operative and early post-operative mortality rate, post-operative ventilation duration, duration of post-operative intensive care unit (ICU) stay, need for post-operative extra-corporeal membrane oxygenation (ECMO) support rate, transcatheter re-intervention rate, unplanned re-operation rate, freedom from right ventricular outflow tract (RVOT) re-intervention, and length of hospital stay (LOS) were the evaluated outcome parameters.

RESULTS: Four comparative studies reporting a total of 264 patients who underwent SR (167 patients) or CR (97 patients) were included. Total mortality was higher in the SR group compared to the CR group (odds ratio (OR) 2.58, P  = 0.03). Two groups were comparable regarding operative and early post-operative mortality (OR 1.37, P  = 0.62), post-operative ventilation duration (mean difference (MD) - 1.58, P  = 0.43), need for post-operative ECMO support rate (OR 4.72, P  = 0.16), transcatheter re-intervention rate (OR 0.60, P  = 0.53), unplanned re-operation rate (OR 0.73, P  = 0.57), and LOS (MD - 3.39, P  = 0.45). Higher rate of freedom from RVOT re-intervention was observed in the SR group (OR 4.16, P  = 0.00001).

CONCLUSION: Single-staged early CR of PAVSD significantly reduced total mortality rate as compared with SR. However, there is life-long risk of frequent need for RVOT re-interventions. Future high-quality randomised studies with robust methodological qualities are encouraged to evaluate the optimal timing and technique for repair of PAVSD, by analysing more outcomes in large patient groups and multi-centre studies.