共通動脈幹における右室流出路再建：グラフト使用の有無？ システマティックレビューおよびメタアナリシス

Background: Surgical repair of truncus arteriosus (TA) requires right ventricle-to-pulmonary artery continuity, achieved through either conduit-based (CB) reconstruction or a nonconduit-based (NCB) approach. As the optimal right ventricular outflow tract (RVOT) strategy is still debatable, we conducted a meta-analysis to compare outcomes. Methods: A systematic literature search was performed focusing on studies that compared CB and NCB RVOT reconstruction techniques for the primary correction of TA. Statistical analyses were conducted using RevMan 8.13.0, with effect estimates reported as odds ratios (ORs) and mean differences, along with 95% confidence intervals (CIs). Results: We included seven studies comprising 360 patients, with 174 neonates (48.3%) allocated to the CB group. No significant difference was observed in early mortality [OR 0.61; 95% CI 0.13-2.92; P = .43; I² = 43%] or long-term mortality [OR 1.22; 95% CI 0.09-17.23; P = .83; I² = 78%] between CB and NCB RVOT reconstruction techniques. However, the incidence of RVOT reoperation [OR 3.70; 95% CI 2.02-6.76; P = .003; I² = 0%] and the overall reintervention rate, including both surgical and catheter-based interventions, were higher in the CB cohort [OR 2.45; 95% CI 1.33-4.52; P = .01; I² = 0%]. Conclusion: While CB and NCB approaches yield similar early and long-term survival outcomes, CB reconstruction is associated with a significantly higher risk of RVOT reoperation and overall reintervention. These findings suggest that NCB approaches may offer superior long-term durability, reducing the need for subsequent interventions in neonates undergoing primary repair of TA.