Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, USA.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, USA.
Int J Cardiol. 2019 Mar 1;278:300-306. doi: 10.1016/j.ijcard.2018.12.025. Epub 2018 Dec 12.
Minimally invasive mitral valve surgery (MIMVS) is performed with increasing frequency. However, patients undergoing MIMVS might be at increased risk of perioperative stroke, mainly due to retrograde aortic embolization during femoral cardio-pulmonary bypass. Pre-operative computed tomography (CT) screening allows visualization of the aorta and femoro-iliac vessels and individualization of the surgical approach. In this meta-analysis, we aim to determine if systematic pre-operative CT screening is associated with decreased incidence of post-operative stroke and other complications following MIMVS.
A comprehensive review was performed in PubMed (inception-May 2018). Eligible studies included those which reported on MIMVS (mini-thoracotomy, port access or robotic approach) with retrograde arterial perfusion. Studies were separated into two subgroups: systematic pre-operative CT screening (CT-group) and no CT screening (Non-CT). Pooled event rates (PER) for operative mortality, post-operative stroke, perioperative myocardial infarction (MI), and new onset renal failure requiring dialysis were estimated and inter-group comparisons were performed.
Data from 57 studies (13,731 patients) were analyzed (19 CT-group, 38 Non-CT). PER for post-operative stroke was 2.0% with a statistically significant difference between the groups (CT-group: 1.5% versus Non-CT: 2.2%, P = 0.03). PER for new dialysis was 1.9%, significantly lower in the CT-group (0.8% versus 2.3% in the Non-CT group, P = 0.02). PER for operative mortality was 1.4% with a trend towards better outcomes in the CT-group (0.8% versus 1.6% in the Non-CT group, P = 0.05).
Systematic pre-operative CT screening is associated with lower risk of post-operative stroke and need for dialysis and a trend toward lower operative mortality after MIMVS.
微创二尖瓣手术（MIMVS）的应用频率正在逐渐增加。然而，接受 MIMVS 的患者可能会增加围手术期卒中的风险，这主要是由于股心肺转流期间逆行主动脉栓塞所致。术前计算机断层扫描（CT）筛查可使主动脉和股髂血管可视化，并使手术方法个体化。在这项荟萃分析中，我们旨在确定系统性术前 CT 筛查是否与 MIMVS 术后卒中发生率及其他并发症降低相关。
我们在 PubMed 上进行了全面的文献回顾（从创建至 2018 年 5 月）。纳入的研究报告了逆行动脉灌注的微创二尖瓣手术（小开胸、端口接入或机器人辅助方法）。研究分为两组：系统性术前 CT 筛查（CT 组）和无 CT 筛查（非 CT 组）。汇总手术死亡率、术后卒中、围手术期心肌梗死（MI）和新出现的需要透析的肾功能衰竭的发生率（PER），并进行组间比较。
共分析了 57 项研究（13731 例患者）的数据（CT 组 19 项，非 CT 组 38 项）。术后卒中的 PER 为 2.0%，两组间有统计学差异（CT 组：1.5%，非 CT 组：2.2%，P=0.03）。新透析的 PER 为 1.9%，CT 组显著降低（0.8%比非 CT 组的 2.3%，P=0.02）。手术死亡率的 PER 为 1.4%，CT 组的结局有改善趋势（0.8%比非 CT 组的 1.6%，P=0.05）。
系统性术前 CT 筛查与 MIMVS 术后卒中、透析需求降低以及手术死亡率降低相关。
