*Purpose: Bronchial artery revascularization (BAR) during lung transplantation has been hypothesized to improve early tracheal healing and delay the onset of bronchiolitis obliterans. We evaluated the available medical literature to examine long-term outcomes and survival for lung transplantation and BAR.

*Methods: Electronic search was performed to identify all relevant studies published about lung transplantation with BAR. Overall, 7 studies were selected for the analysis comprising 143 patients. Cohort-level data were extracted and pooled for analysis.

*Results: Mean patient age was 47 [95% CI 40-55] years. 61% [50-71] were male. 66% [6-98] of patients underwent double lung transplant while 34% [2-94] underwent single lung transplant. With respect to indications, 71% [38-91] had emphysema, 40% [2-96] had alpha-1 antitrypsin deficiency, 24% [0-100] had cystic fibrosis, 26% [4-75] had pulmonary fibrosis, and 6% [2-17] had pulmonary hypertension. 91% [46-99] of these transplants used the internal mammary conduit for BAR while 7% [1-51] used a saphenous vein conduit. Of patients who underwent post-operative angiography, successful BAR was demonstrated in 93% [82-97] of all conduits. 87% [65-96] ultimately demonstrated healed tracheal anastomosis. Post-operatively, 18% [9-31] had a bleeding complication of some kind with 14% [4-41] requiring surgical exploration due to significant bleeding. This total increased to 20% [9-38] requiring reoperation for any indication. The 30-day mortality was 9% [4-20] with ultimate cause of death being respiratory failure in 8% [0-99] and multi-organ failure in 6% [3-11] of patients. 79% [63-89] of patients were free from rejection at three months. 84% [49-97] were free from anastomotic intervention at both three and six months. 83% [29-98] of patients were free from signs of airway ischemia at 3 and 6 months. Pooled survival analysis (Figure 1A) demonstrates 87% [78-92] and 71% [46-87] survival at one year and five years, respectively, with a mean follow-up time of 21 [3-38] months. Pooled freedom from bronchiolitis obliterans (Figure 1B) demonstrated 86% [77-91] of patients free from BOS at two years.

*Conclusions: BAR is a viable technique to minimize BOS and early anastomotic intervention following lung transplant. Further comparative analysis should be performed to evaluate this surgical technique versus standard practice.

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