Imperial College NHLI, and Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy.
Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy.
Ann Thorac Surg. 2020 Mar;109(3):737-744. doi: 10.1016/j.athoracsur.2019.07.034. Epub 2019 Aug 31.
There is high demand for minimally invasive mitral valve repair; however, it is unclear whether the minimally invasive approach provides the same performance as conventional sternotomy in a context of complex mitral valve disease. Here, we compared outcomes of minimally invasive and sternotomy procedures for bileaflet and Barlow's mitral valve disease.
We performed a pooled meta-analysis of studies reporting early and late follow-up of mitral valve repair for complex mitral valve regurgitation. The primary outcome was moderate mitral valve regurgitation recurrence and need for reoperation. Secondary outcomes included operation time, reopening for bleeding, associated tricuspid procedures, failed repair, and inhospital mortality. Incidence rates were calculated for long-term follow-up. Effect estimates were calculated as incidence rates with 95% confidence intervals. When Kaplan-Meier curves were available, event rates were estimated from the curves with Plot Digitizer software; otherwise, reported event rates were used to calculate incidence rates.
Eighteen studies including 1905 patients (654 minimally invasive and 1251 sternotomy) with a mean follow-up of 51.6 months (range, 14 to 138) were meta-analyzed with a random model. There were no significant between-group differences in moderate mitral valve regurgitation recurrence and reoperation (minimally invasive vs sternotomy, 1.7% [95% confidence interval, 1.0% to 2.9%] vs 1.3% [95% confidence interval, 0.9% to 1.8%], P = .22). Patients in the minimally invasive group were exposed to significantly longer cross-clamp and cardiopulmonary bypass times (P < .01); however, there were no additional between-group differences in secondary outcomes.
This meta-analysis has demonstrated that minimally invasive and sternotomy approaches produce comparable results for complex mitral valve repair.
微创二尖瓣修复术的需求很高；然而，在复杂二尖瓣疾病的背景下，微创方法是否能提供与传统胸骨切开术相同的效果尚不清楚。在这里，我们比较了微创和胸骨切开术治疗双叶瓣和巴洛氏二尖瓣疾病的结果。
我们对报告复杂二尖瓣反流行二尖瓣修复术早期和晚期随访的研究进行了荟萃分析。主要结局是中度二尖瓣反流复发和需要再次手术。次要结局包括手术时间、再次出血开胸、相关三尖瓣手术、修复失败和住院死亡率。计算了长期随访的发生率。效应估计值计算为 95%置信区间的发生率。当有 Kaplan-Meier 曲线时，使用 Plot Digitizer 软件从曲线中估计事件率；否则，使用报告的事件率计算发生率。
共纳入 18 项研究，包括 1905 例患者（微创 654 例，胸骨切开 1251 例），平均随访 51.6 个月（范围为 14 至 138），采用随机模型进行荟萃分析。两组中度二尖瓣反流复发和再次手术无显著差异（微创组 1.7%[95%置信区间，1.0%至 2.9%]与胸骨切开组 1.3%[95%置信区间，0.9%至 1.8%]，P=.22）。微创组患者的体外循环和主动脉阻断时间明显较长（P <.01）；然而，在次要结局方面，两组之间没有其他差异。
这项荟萃分析表明，微创和胸骨切开术治疗复杂二尖瓣修复的效果相当。
