Department of Pediatric Cardiology, Hospital de Santa Cruz - Centro Hospitalar Universitário Lisboa Ocidental, Carnaxide, Portugal; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK; Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
J Pediatr Surg. 2023 Sep;58(9):1744-1753. doi: 10.1016/j.jpedsurg.2023.02.058. Epub 2023 Feb 28.
Vascular rings may cause tracheal and/or oesophageal compression. For many patients, symptoms/signs have been present for a long period before diagnosis. However, in the era of prenatal diagnosis, some units advocate universal early surgery. The risks and efficacy of surgery must be known to adequately counsel for the operation. This meta-analysis sought to define the morbidity and mortality associated with surgical correction, and persistent post-operative symptoms.
PubMed, Cochrane Library and CINAHL databases were searched for studies that described the outcome of patients undergoing surgery for a double or right aortic arch (DAA or RAA). Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled rates of mortality, surgical complications, reintervention, and persistent follow-up symptoms.
Nineteen eligible studies were included comprising 18 studies describing outcomes for DAA surgery and 15 for RAA surgery. For DAA surgery, overall mortality rate was 0% [95% confidence interval (CI) 0.0-1.0], post-surgical complication rate 18% [95% CI: 12.0-23.0], prevalence of reintervention 3% [95% CI: 1.0-5.0] and prevalence of symptoms at last follow-up was 33% [95% CI: 17.0-52.0]. For RAA surgery, overall pooled mortality was 0% [95% CI: 0.0-0.0], prevalence of post-surgical complications was 15% [95% CI: 8.0-23.0], reintervention rate was 2% [95% CI: 0.0-4.0], prevalence of symptoms at last follow-up was 40% [95% CI: 26.0-55.0].
While surgery to correct a vascular ring is safe, the rate of persistent symptoms is high and further strategies must be sought to reduce this burden.
血管环可能导致气管和/或食管受压。对于许多患者，在诊断之前，症状/体征已经存在很长一段时间。然而，在产前诊断时代，一些单位主张普遍早期手术。为了充分告知手术，必须了解手术的风险和疗效。本荟萃分析旨在确定手术矫正相关的发病率和死亡率，以及持续性术后症状。
检索了描述接受双主动脉弓（DAA 或 RAA）手术治疗的患者结局的研究，包括 PubMed、Cochrane 图书馆和 CINAHL 数据库。进行了非比较和随机效应模型的荟萃分析，以计算死亡率、手术并发症、再次干预和持续性随访症状的汇总率。
纳入了 19 项符合条件的研究，其中 18 项研究描述了 DAA 手术的结果，15 项研究描述了 RAA 手术的结果。对于 DAA 手术，总死亡率为 0%（95%置信区间 0.0-1.0），术后并发症发生率为 18%（95%置信区间 12.0-23.0），再次干预的发生率为 3%（95%置信区间 1.0-5.0），最后一次随访时症状的发生率为 33%（95%置信区间 17.0-52.0）。对于 RAA 手术，总体汇总死亡率为 0%（95%置信区间 0.0-0.0），术后并发症发生率为 15%（95%置信区间 8.0-23.0），再次干预率为 2%（95%置信区间 0.0-4.0），最后一次随访时症状的发生率为 40%（95%置信区间 26.0-55.0）。
虽然纠正血管环的手术是安全的，但持续性症状的发生率很高，必须寻求进一步的策略来减轻这种负担。
