经胸钳夹与主动脉内球囊阻断在微创二尖瓣手术中的应用：系统评价和荟萃分析。
Transthoracic clamp versus endoaortic balloon occlusion in minimally invasive mitral valve surgery: a systematic review and meta-analysis.
机构信息
University of Bristol Medical School, Bristol, UK.
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
出版信息
Eur J Cardiothorac Surg. 2019 Oct 1;56(4):643-653. doi: 10.1093/ejcts/ezy489.
This systematic review and meta-analysis aims to determine outcomes following aortic occlusion with the transthoracic clamp (TTC) versus endoaortic balloon occlusion (EABO) in patients undergoing minimally invasive mitral valve surgery. A subgroup analysis compares TTC to EABO with femoral cannulation separately from EABO with aortic cannulation. We searched Medline and Embase up to December 2018. Two people independently and in duplicate screened title and abstracts, full-text reports, extracted data and assessed the risk of bias using the Cochrane risk-of-bias tool for non-randomized studies. We identified 1564 reports from which 11 observational studies with 4181 participants met the inclusion criteria. We found no evidence of difference in the risk of postoperative death or cerebrovascular accident (CVA) between the 2 techniques. Evidence for a reduction in aortic dissection with TTC was found: 4 of 1590 for the TTC group vs 19 of 2492 for the EABO group [risk ratio 0.33, 95% confidence interval (CI) 0.12-0.93; P = 0.04]. There was no difference in aortic cross-clamp (AoX) time between TTC and EABO [mean difference (MD) -5.17 min, 95% CI -12.40 to 2.06; P = 0.16]. TTC was associated with a shorter AoX time compared to EABO with femoral cannulation (MD -9.26 min, 95% CI -17.00 to -1.52; P = 0.02). EABO with aortic cannulation was associated with a shorter AoX time compared to TTC (MD 7.77 min, 95% CI 3.29-12.26; P < 0.001). There was no difference in cardiopulmonary bypass (CPB) time between TTC and EABO with aortic cannulation (MD -4.98 min, 95% CI -14.41 to 4.45; P = 0.3). TTC was associated with a shorter CPB time compared to EABO with femoral cannulation (MD -10.08 min, 95% CI -19.93 to -0.22; P = 0.05). Despite a higher risk of aortic dissection with EABO, the rates of survival and cerebrovascular accident across the 2 techniques are similar in minimally invasive mitral valve surgery.
这篇系统评价和荟萃分析旨在确定在接受微创二尖瓣手术的患者中，经胸阻断（TTC）与腔内球囊阻断（EABO）在主动脉阻断方面的结果。亚组分析分别比较了 TTC 与股动脉插管的 EABO 以及 TTC 与主动脉插管的 EABO。我们检索了 Medline 和 Embase 截至 2018 年 12 月的文献。两名研究人员独立地、重复地筛选标题和摘要、全文报告、提取数据，并使用 Cochrane 非随机研究偏倚风险工具评估偏倚风险。我们从 1564 篇报告中确定了 11 项符合纳入标准的观察性研究，共有 4181 名参与者。我们没有发现两种技术之间术后死亡或脑血管意外（CVA）风险的差异证据。TTC 降低主动脉夹层的证据如下：TTC 组 4 例，EABO 组 19 例[风险比 0.33，95%置信区间（CI）0.12-0.93；P=0.04]。TTC 与 EABO 之间的主动脉阻断时间（AoX）无差异[TTC 组平均差值（MD）-5.17 分钟，95%CI-12.40 至 2.06；P=0.16]。与 TTC 相比，TTC 与股动脉插管的 EABO 时间更短（MD-9.26 分钟，95%CI-17.00 至-1.52；P=0.02）。与 TTC 相比，EABO 与主动脉插管的 AoX 时间更短（MD7.77 分钟，95%CI3.29-12.26；P<0.001）。TTC 与 EABO 与主动脉插管的体外循环（CPB）时间无差异（MD-4.98 分钟，95%CI-14.41 至 4.45；P=0.3）。与 TTC 相比，EABO 与股动脉插管的 CPB 时间更短（MD-10.08 分钟，95%CI-19.93 至-0.22；P=0.05）。尽管 EABO 主动脉夹层的风险较高，但微创二尖瓣手术中两种技术的生存率和脑血管意外发生率相似。
Zotero 插件