Dieberg Gudrun, Smart Neil A, King Nicola
School of Science and Technology, University of New England, Armidale, NSW 2350, Australia.
School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth PL4 8AA, UK.
Int J Cardiol. 2016 Nov 15;223:554-560. doi: 10.1016/j.ijcard.2016.08.227. Epub 2016 Aug 16.
Minimally invasive (MI) cardiac surgery was introduced to reduce problems associated with a full sternotomy. This meta-analysis aimed to investigate the effects of minimally invasive cardiac surgery on a range of clinical outcomes.
To identify potential studies (randomised/prospective clinical trials) systematic searches were carried out. The search strategy included the concepts of "minimally invasive" OR "MIDCAB" AND "coronary artery bypass grafting" OR "cardiac surgery". This was followed by a meta-analysis investigating cross-clamp time, cardiopulmonary bypass (CPB) time, operation time, ventilation time, intensive care unit (ICU) stay, hospital stay, incidence of myocardial infarction and of stroke/neurologic complications.
Eight studies (9 intervention groups), totalling 596 participants were analysed. MI cardiac surgery was associated with a shorter ICU stay mean difference (MD) -0.7days (95% confidence interval (CI) -1.23 to -0.18, p=0.009) and longer cross-clamp MD 6.7min (95% CI 1.24 to 12.17, p=0.02), CPB MD 26.68min (95% CI 10.31 to 43.05, p=0.001), and operation times MD 55.03min (95% CI 22.76 to 87.31, p=0.0008). However no differences were found in the ventilation time MD -3.94h (95% CI -8.09 to 0.21, p=0.06), length of hospital stay MD -1.14days (95% CI -3.11 to 0.83, p=0.26) and in the incidence of myocardial infarction odds ratio (OR) 1.97 (95% CI 0.49 to 7.9, p=0.34) or stroke/neurologic complications OR 0.67 (95% CI 0.11 to 4.05, p=0.66).
Minimally invasive cardiac surgery is as safe as conventional surgery and could reduce costs due to a shorter period spent in ICU.
微创心脏手术被引入以减少与全胸骨切开术相关的问题。本荟萃分析旨在研究微创心脏手术对一系列临床结局的影响。
为识别潜在研究（随机/前瞻性临床试验）进行了系统检索。检索策略包括“微创”或“微创冠状动脉搭桥术”以及“冠状动脉搭桥术”或“心脏手术”等概念。随后进行荟萃分析，研究阻断时间、体外循环（CPB）时间、手术时间、通气时间、重症监护病房（ICU）停留时间、住院时间、心肌梗死发生率和中风/神经并发症发生率。
分析了八项研究（9个干预组），共596名参与者。微创心脏手术与较短的ICU停留时间相关，平均差值（MD）为-0.7天（95%置信区间（CI）-1.23至-0.18，p = 0.009），以及较长的阻断时间MD为6.7分钟（95%CI 1.24至12.17，p = 0.02）、CPB时间MD为26.68分钟（95%CI 10.31至43.05，p = 0.001）和手术时间MD为55.03分钟（95%CI 22.76至87.31，p = 0.0008）。然而，在通气时间MD为-3.94小时（95%CI -8.09至0.21，p = 0.06）、住院时间MD为-1.14天（95%CI -3.11至0.83，p = 0.26）以及心肌梗死发生率优势比（OR）为1.97（95%CI 0.49至7.9，p = 0.34）或中风/神经并发症OR为0.67（95%CI 0.11至4.05，p = 0.66）方面未发现差异。
微创心脏手术与传统手术一样安全，并且由于在ICU的停留时间较短，可能降低成本。
