PMID- 29972332
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231005
IS  - 2045-8932 (Print)
IS  - 2045-8940 (Electronic)
IS  - 2045-8932 (Linking)
VI  - 9
IP  - 1
DP  - 2019 Jan-Mar
TI  - The efficacy and safety of pulmonary vasodilators in patients with Fontan 
      circulation: a meta-analysis of randomized controlled trials.
PG  - 2045894018790450
LID - 10.1177/2045894018790450 [doi]
LID - 2045894018790450
AB  - No previous meta-analysis has evaluated the efficacy and safety of pulmonary 
      vasodilators in Fontan physiology. Recent relative trials have obtained 
      conflicting results regarding improvements in peak oxygen consumption; the 
      relatively small number of patients in each study may be a limiting factor. We 
      aimed to evaluate the efficacy and safety of pulmonary vasodilators in Fontan 
      patients. Relevant studies were identified by searching the PubMed, Embase, and 
      Cochrane Library databases. Pooled outcomes were determined to assess the 
      efficacy and safety of pulmonary vasodilators in Fontan patients. Nine randomized 
      controlled studies involving 381 patients with Fontan circulation were included. 
      Pulmonary vasodilator therapy led to significant improvement (mean 
      difference = -0.39, 95% CI: [-0.72, -0.05]) in the New York Heart Association 
      (NYHA) functional class. The 6-minute walking distance (6MWD) was significantly 
      increased by 134 m (95% CI: [86.07, 181.94]), and the peak VO(2) was also 
      significantly improved (mean difference = 1.42 ml.(kg.min)(-1), 95% CI: [0.21, 
      2.63]). Additionally, the mean pulmonary artery pressure (mPAP) was significantly 
      reduced (mean difference = -2.25 mmHg, 95% CI: [-3.00, -1.50]). No significant 
      change was found in mortality or in brain natriuretic peptide (BNP) or N-terminal 
      pronatriuretic peptide (NT-proBNP). Four studies reported no side effects and 
      good drug tolerance, and two studies reported mild adverse effects. The present 
      meta-analysis indicated that pulmonary vasodilators (primarily the PDE-5 
      inhibitor and endothelin-1 receptor antagonist) significantly improved the 
      hemodynamics of Fontan patients, reduced the NYHA functional class and increased 
      the 6MWD. The peak oxygen consumption was also improved. No significant change 
      was observed in mortality or in the BNP or NT-proBNP level. Overall, the 
      pulmonary vasodilators were well tolerated. This finding needs to be confirmed in 
      future studies.
FAU - Wang, Wuwan
AU  - Wang W
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
FAU - Hu, Xiankang
AU  - Hu X
AD  - 2 Chongqing Medical University, Chongqing, China.
FAU - Liao, Weitin
AU  - Liao W
AD  - 2 Chongqing Medical University, Chongqing, China.
FAU - Rutahoile, W H
AU  - Rutahoile WH
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
FAU - Malenka, David J
AU  - Malenka DJ
AD  - 3 Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, 
      Lebanon, USA.
FAU - Zeng, Xiaofang
AU  - Zeng X
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
FAU - Yang, Yunjing
AU  - Yang Y
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
FAU - Feng, Panpan
AU  - Feng P
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
FAU - Wen, Li
AU  - Wen L
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
FAU - Huang, Wei
AU  - Huang W
AD  - 1 Department of Cardiology, the First Affiliated Hospital, Chongqing Medical 
      University, Chongqing, China.
LA  - eng
PT  - Journal Article
DEP - 20180704
PL  - United States
TA  - Pulm Circ
JT  - Pulmonary circulation
JID - 101557243
PMC - PMC6348526
OTO - NOTNLM
OT  - Fontan procedure
OT  - PDE-5 inhibitor
OT  - endothelin-1 receptor antagonist
OT  - outcomes
EDAT- 2018/07/05 06:00
MHDA- 2018/07/05 06:01
PMCR- 2019/01/14
CRDT- 2018/07/05 06:00
PHST- 2018/07/05 06:00 [pubmed]
PHST- 2018/07/05 06:01 [medline]
PHST- 2018/07/05 06:00 [entrez]
PHST- 2019/01/14 00:00 [pmc-release]
AID - 10.1177_2045894018790450 [pii]
AID - 10.1177/2045894018790450 [doi]
PST - ppublish
SO  - Pulm Circ. 2019 Jan-Mar;9(1):2045894018790450. doi: 10.1177/2045894018790450. 
      Epub 2018 Jul 4.