• Paulo Ernando Ferraz Cavalcanti, Michel Pompeu Barros Oliveira Sá, Cecília Andrade Santos, Isaac Melo Esmeraldo, Rodrigo Renda de Escobar, Alexandre Motta de Menezes, Orlando Morais de Azevedo, Frederico Pires de Vasconcelos Silva, Ricardo Felipe de Albuquerque Lins, and Ricardo de Carvalho Lima.
• Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, Recife, Pernambuco, Brazil; Department of Cardiothoracic Surgery, University of Pernambuco, UPE, Recife, Pernambuco, Brazil; Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, FCM/ICB, Recife, Pernambuco, Brazil. Electronic address: pauloernando@sbccv.org.br.
• J. Am. Coll. Cardiol. 2013 Dec 10;62(23):2227-43.

AbstractBecause the real benefit of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot who develop pulmonary insufficiency remains unclear, it is necessary to analyze the evidence published around the world. We performed a systematic review of studies that reported data about the effect of PVR in patients with repaired tetralogy of Fallot that developed pulmonary insufficiency, until December 2012. The variables chosen to represent the benefit were both right ventricular (RV) and left ventricular measures, QRS duration, and functional class. The principal summary measures were difference in means with 95% confidence interval and p values (considered statistically significant when p < 0.05). The differences in means were combined across studies with the weighted DerSimonian-Laird random effects model. Meta-analysis, sensitivity analysis, and meta-regression were completed with the software Comprehensive Meta-Analysis (version 2, Biostat, Inc., Englewood, New Jersey). Forty-eight studies involving 3,118 patients met the eligibility criteria. The pooled 30-day mortality was 0.87% (47 studies; 27 of 3,100 patients); the pooled 5-year mortality was 2.2% (24 studies; 49 of 2,231 patients); the pooled 5-year re-PVR was 4.9% (15 studies; 88 of 1,798 patients). The results of this meta-analysis demonstrate that after PVR: 1) the RV experiences improvement of its volumes and function; 2) the left ventricle experiences improvement of its function; 3) QRS duration decreases; 4) symptoms improve; 5) pre-operative RV geometry modulates the effect of PVR; and 6) there is important heterogeneity of the effects among the studies, and few publication biases. In conclusion, PVR seems to be a positive approach in the analyzed scenario.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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