Agasthi Pradyumna, Sridhara Srilekha, Rattanawong Pattara, Venepally Nithin, Chao Chieh-Ju, Ashraf Hasan, Pujari Sai Harika, Allam Mohamed, Almader-Douglas Diana, Alla Yamini, Kumar Amit, Mookadam Farouk, Packer Douglas L, Holmes David R, Hagler Donald J, Fortuin Floyd David, Arsanjani Reza
Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States.
Department of Internal Medicine, Banner Heart Hospital, Mesa, AZ 85054, United States.
World J Cardiol. 2023 Feb 26;15(2):64-75. doi: 10.4330/wjc.v15.i2.64.
Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI).
To study the safety and efficacy outcomes of PBA PSI in all patient categories with PVS.
We performed a literature search of all studies comparing outcomes of patients evaluated by PBA PSI for PVS. We selected all published studies comparing PBA PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity.
Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, = 0.025, = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, = 0.929), = 0.0%).
Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.
肺静脉狭窄（PVS）在成人和儿童中虽不常见，但却是发病和死亡的已知原因，可通过肺静脉球囊血管成形术（PBA）或肺静脉支架植入术（PSI）等经皮血管重建策略进行治疗。
研究PBA和PSI治疗所有类型PVS患者的安全性和疗效结果。
我们对所有比较PBA和PSI评估PVS患者结局的研究进行了文献检索。我们选择了所有已发表的比较PBA和PSI治疗PVS的研究，并报告了所有类型患者的再狭窄和手术相关并发症的结局。在成人中，纳入房颤消融术后的PVS，在儿童中，纳入与先天性病因相关的PVS或完全或部分肺静脉异位引流修复术后的术后PVS。以患者为中心的结局是需要再次干预的再狭窄风险和手术相关并发症。基于潜在的统计异质性，采用随机效应模型计算比值比（OR）进行荟萃分析。
八项观察性研究共治疗了487例患者的768例严重PVS，符合我们的纳入标准。患者年龄范围为6个月至70岁，67%为男性。PBA组325条静脉中有196条发生需要再次干预的再狭窄主要结局，PSI组443条静脉中有111条发生。与PSI相比，PBA再狭窄风险显著增加（OR 2.91，95%CI：1.15 - 7.37，P = 0.025，I² = 79.2%）。PBA组122例患者中有7例发生手术相关并发症的次要结局，PSI组69例中有6例发生。两组安全性结局无统计学显著差异（OR：0.94，95%CI：0.23 - 3.76，P = 0.929，I² = 0.0%）。
在所有类型的PVS患者中，PSI与再次干预风险降低相关，且与PBA一样安全，应被视为PVS的一线治疗方法。
