Tracheoplasty for Patients with Pulmonary Artery Sling and Tracheal Stenosis: A Meta-Analysis
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ORIGINAL ARTICLE
Tracheoplasty for Patients with Pulmonary Artery Sling and Tracheal Stenosis: A Meta‑Analysis Dongxu Li1 · Xu Zhou2 · Mengsi Li3 Received: 3 March 2020 / Accepted: 23 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We performed this meta-analysis to assess the safety and efficacy of tracheoplasty for patients with pulmonary artery sling (PAS) and tracheal stenosis. Published studies that included surgical treatment of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and Cochrane Library databases until May 2020. The outcomes assessed included postoperative ventilation time, early and late mortality, and follow-up respiratory symptoms. The mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CI) was estimated with a random-effects/fixed-effects model. Subgroup analysis was performed stratified by percentage of patients with tracheal rings. A total of eight studies comprising 219 patients with PAS accompanied by tracheal stenosis were included. The pooled estimates of postoperative ventilation time (MD 17.68, 95% CI 6.38 to 28.98, p < 0.01) and early mortality (RR 3.93, 95% CI 1.55 to 9.95, p < 0.01) favored the repair-only group. Late mortality (RR 1.33, 95% CI 0.48 to 3.68, p = 0.58) and respiratory symptoms (RR 1.51, 95% CI 0.50 to 4.57, p = 0.47) at follow-up showed no significant differences between the groups with repair-only and repair with tracheoplasty. The same results were found in subgroup analyses. For the surgical treatment of PAS with tracheal stenosis, repair without tracheoplasty appears to result in shorter postoperative ventilation time and lower early mortality, with no increase in late mortality or respiratory symptoms at follow-up, compared with concomitant tracheoplasty. Keywords Pulmonary artery sling · Tracheal stenosis · Repair · Tracheoplasty · Meta-analysis
Introduction Pulmonary artery sling (PAS) is a rare congenital heart disease in which the left pulmonary artery (LPA) originates from the right pulmonary artery and surrounds the distal trachea and right main bronchus [1]. PAS patients often have respiratory symptoms due to exogenous tracheal Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00246-020-02386-z) contains supplementary material, which is available to authorized users. * Dongxu Li [email protected] 1
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan, People’s Republic of China
2
Evidence‑Based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
3
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
compression caused by abnormal LPA, sometimes with severe diffuse tracheal stenosis caused by complete cartilage rings [2]. Complete-ring cases have been reported to account for approx
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