Raja Shahzad G, Navaratnarajah Manoraj
Department of Cardiac Surgery, Harefield Hospital, London, UK.
J Card Surg. 2009 Jan-Feb;24(1):73-9. doi: 10.1111/j.1540-8191.2008.00744.x.
Recent years have seen a surge in the enthusiasm to perform minimal access valve surgery to reduce morbidity and improve clinical outcomes. Despite tremendous enthusiasm on the part of proponents of minimal access valve surgery, skepticism still exists about the actual impact of minimal access valve surgery in reducing postoperative morbidity. This review article attempts to evaluate the current best available evidence on the impact of minimal access valve surgery on postoperative clinical outcomes.
The English language scientific literature was reviewed primarily by searching Medline from 1966 through February 2008 using PubMed interface. All blinded or unblinded randomized clinical trials, comparing minimal access valve surgery with conventional valve surgery through a full sternotomy, recruiting adult human patients undergoing valve repair, or replacement and reporting impact of these two approaches on at least 1 pertinent clinical or economic outcome, were included.
Current best available evidence from randomized clinical trials (Grade A, Level 1b) does not show any significant quantitative differences between minimal access valve surgery and conventional valve surgery for perioperative mortality or other primary outcome events of stroke, renal failure, or respiratory failure. There are small but statistically significant benefits for minimal access valve surgery for surrogate outcomes of ventilation time, intensive care unit stay, and total length of stay.
The published evidence is thin and a large multicenter randomized clinical trial with preferably standardization of minimal access valve surgery techniques and long term follow-up is required to validate the safety and efficacy of minimal access valve surgery.
近年来，开展微创瓣膜手术以降低发病率并改善临床结局的热情高涨。尽管微创瓣膜手术的支持者热情极高，但对于微创瓣膜手术在降低术后发病率方面的实际影响仍存在怀疑。这篇综述文章试图评估关于微创瓣膜手术对术后临床结局影响的当前最佳现有证据。
主要通过使用PubMed界面在1966年至2008年2月期间检索Medline来回顾英文科学文献。纳入所有比较微创瓣膜手术与通过全胸骨切开术的传统瓣膜手术的盲法或非盲法随机临床试验，招募接受瓣膜修复或置换的成年患者，并报告这两种方法对至少1项相关临床或经济结局的影响。
来自随机临床试验（A级，1b级）的当前最佳现有证据表明，在围手术期死亡率或中风、肾衰竭或呼吸衰竭等其他主要结局事件方面，微创瓣膜手术与传统瓣膜手术之间没有任何显著的定量差异。对于通气时间、重症监护病房住院时间和总住院时间等替代结局，微创瓣膜手术有小但具有统计学意义的益处。
已发表的证据不足，需要进行一项大型多中心随机临床试验，最好对微创瓣膜手术技术进行标准化并进行长期随访，以验证微创瓣膜手术的安全性和有效性。
