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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis
Pradyumna Agasthi, Srilekha Sridhara, Pattara Rattanawong, Nithin Venepally, Chieh-Ju Chao, Hasan Ashraf, Sai Harika Pujari, Mohamed Allam, Diana Almader-Douglas, Yamini Alla, Amit Kumar, Farouk Mookadam, Douglas L Packer, David R Holmes Jr, Donald J Hagler, Floyd David Fortuin, Reza Arsanjani
Pradyumna Agasthi, Pattara Rattanawong, Nithin Venepally, Chieh-Ju Chao, Hasan Ashraf, Sai Harika Pujari, Mohamed Allam, Amit Kumar, Farouk Mookadam, Floyd David Fortuin, Reza Arsanjani, Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
Srilekha Sridhara, Department of Internal Medicine, Banner Heart Hospital, Mesa, AZ 85054, United States
Diana Almader-Douglas, Library Services, Mayo Clinic, Phoenix, AZ 85054, United States
Yamini Alla, Department of Medicine, Bronx Lebanon Hospital, Bronx, NY 10457, United States
Douglas L Packer, David R Holmes Jr, Donald J Hagler, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Agasthi P and Sridhara S contributed equally to this work; Agasthi P, Sridhara S, Mookadam F, Fortuin FD and Arsanjani R, designed the research study; Agasthi P, Sridhara S, Rattanawong P, Venepally NR, Chao C, Ashraf H and Pujari S performed the research; Douglas DA, Allam Mohamed, Alla Y, Kumar A contributed new reagents and analytic tools; Agasthi P, Sridhara S, Rattanawong P, Venepally NR, Chao C, Ashraf H, Pujari S and Allam M analyzed the data and wrote the manuscript; Mookadam F, Packer DL, Holmes DR Jr, Hagler DJ, Fortuin FD and Arsanjani R reviewed the manuscript before submission; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors received no financial support for the research, authorship, and/or publication of this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Nithin Venepally, MD, Academic Research, Department of Cardiovascular Diseases, Mayo Clinic, 5777 E Mayo Blvd, Scottsdale, AZ 85259, United States. nrvenepally@gmail.com
Received: September 19, 2022
Peer-review started: September 19, 2022
First decision: November 2, 2022
Revised: November 17, 2022
Accepted: February 8, 2023
Article in press: Feburary 8, 2023
Published online: February 26, 2023
Processing time: 155 Days and 3.5 Hours
BACKGROUND
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).
AIM
To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.
METHODS
We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs 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.
RESULTS
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, P = 0.025, I2 = 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, P = 0.929), I2 = 0.0%).
CONCLUSION
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.
Core Tip: 81.5% of patients with pulmonary vein stenosis undergoing a transcatheter intervention reported symptom of dyspnea. Pulmonary vein stent implantation (PSI) was superior to pulmonary vein balloon angioplasty (PBA) in preventing restenosis of the pulmonary vein. No difference in procedural related complications was noted between PSI and PBA. Differences in peri-procedural anticoagulation strategies between studies could have affected the outcome.
