Boulemden Anas, Nadarajah Dharsicka, Szafranek Adam, Richens David
Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK.
Interact Cardiovasc Thorac Surg. 2018 Oct 1;27(4):536-542. doi: 10.1093/icvts/ivy111.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether there was a difference in postoperative outcomes [namely permanent pacemaker (PPM) insertion, rhythm disturbance, reoperation for bleeding, hospital stay and in-hospital mortality] between trans-septal or superior (extended) trans-septal (STS) approaches in comparison with the conventional left atriotomy (LA) used in mitral valve surgery. Using the reported search strategy, 353 papers were found of which 11 represented the best evidence to answer the clinical question. The authors, journal, year and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two papers compared all 3 atrial incisions with neither showing a difference in PPM implantation rate, whereas 2 papers compared just the trans-septal with the LA approach, again both finding no significant difference in PPM implantation. Seven studies compared the STS approach with the LA approach with regard to PPM implantation; 1 study showed that the STS approach was an independent risk factor for PPM implantation, PPM insertion was not necessary in 2 studies and there was no difference in PPM insertion in 4 studies. Postoperative junctional rhythm was studied in 5 papers that compared the STS approach with the LA approach; junctional rhythm was more prevalent in the STS approach in 2 studies, albeit transient, whereas 3 papers did not show a significant difference. Mortality, hospital stay and re-exploration for bleeding did not differ among the 3 groups.
根据结构化方案撰写了一篇心脏外科的最佳证据主题文章。所探讨的问题是，在二尖瓣手术中，经房间隔或上（扩展）经房间隔（STS）入路与传统左心房切开术（LA）相比，术后结果[即永久性起搏器（PPM）植入、心律失常、因出血再次手术、住院时间和院内死亡率]是否存在差异。采用报告的检索策略，共找到353篇论文，其中11篇代表回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表年份和国家、研究的患者群体、研究类型、相关结果及结果制成表格。两篇论文比较了所有三种心房切口，均未显示PPM植入率存在差异，而两篇论文仅比较了经房间隔入路与LA入路，同样都发现PPM植入无显著差异。七项研究比较了STS入路与LA入路在PPM植入方面的情况；一项研究表明，STS入路是PPM植入的独立危险因素，两项研究认为无需植入PPM，四项研究则表明PPM植入无差异。五篇比较STS入路与LA入路的论文研究了术后交界性心律；两项研究表明，STS入路中交界性心律更为普遍，尽管是短暂的，而三篇论文未显示出显著差异。三组在死亡率、住院时间和因出血再次探查方面无差异。
