622170384 Western University, London, ON, Canada.
1857 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Innovations (Phila). 2021 Jul-Aug;16(4):310-316. doi: 10.1177/15569845211000332. Epub 2021 Mar 30.
The safety of minimally invasive mitral valve surgery (MIMVS) in elderly patients is still debated. Our objective was to perform a systematic review and meta-analysis of studies comparing MIMVS with conventional sternotomy (CS) in elderly patients (≥65 years old).
We searched PubMed, EMBASE, Web of Science, clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for trials and observational studies comparing MIMVS with CS in patients ≥65 years old presenting for mitral valve surgery. We performed a random-effects meta-analysis of all outcomes.
The MIMVS group had lower odds of acute renal failure (odds ratio [OR] 0.27; 95% CI 0.10 to 0.78), prolonged intubation (>48 h; OR 0.47; 95% CI 0.31 to 0.70), less blood product transfusion (weighted mean difference [WMD] -0.82 units; 95% CI -1.29 to -0.34 units), shorter ICU length of stay (LOS; WMD -2.57 days; 95% CI -3.24 to -1.90 days) and hospital LOS (WMD -4.06 days; 95% CI -5.19 to -2.94 days). There were no significant differences in the odds of mortality, stroke, respiratory infection, reoperation for bleeding, and postoperative atrial fibrillation. MIMVS was associated with longer cross-clamp (WMD 11.8 min; 95% CI 3.5 to 20.1 min) and cardiopulmonary bypass times (WMD 23.0 min; 95% CI 10.4 to 35.6 min).
MIMVS in elderly patients is associated with lower postoperative complications, blood transfusion, shorter ICU, and hospital LOS, and longer cross-clamp and bypass times.
微创二尖瓣手术（MIMVS）在老年患者中的安全性仍存在争议。我们的目的是对比较 MIMVS 与传统胸骨切开术（CS）在老年患者（≥65 岁）中的研究进行系统评价和荟萃分析。
我们检索了 PubMed、EMBASE、Web of Science、clinicaltrials.gov 和 Cochrane 对照试验中心，以查找比较≥65 岁行二尖瓣手术的患者中 MIMVS 与 CS 的试验和观察性研究。我们对所有结局进行了随机效应荟萃分析。
MIMVS 组急性肾衰竭的几率较低（比值比[OR] 0.27；95%置信区间[CI] 0.10 至 0.78），需要长时间插管（>48 小时；OR 0.47；95% CI 0.31 至 0.70）、较少的血液制品输注（加权均数差[WMD] -0.82 单位；95% CI -1.29 至 -0.34 单位）、较短的 ICU 住院时间（WMD -2.57 天；95% CI -3.24 至 -1.90 天）和住院时间（WMD -4.06 天；95% CI -5.19 至 -2.94 天）。死亡率、中风、呼吸道感染、因出血再次手术和术后心房颤动的几率没有显著差异。MIMVS 与更长的体外循环（WMD 11.8 分钟；95% CI 3.5 至 20.1 分钟）和心肺转流时间（WMD 23.0 分钟；95% CI 10.4 至 35.6 分钟）相关。
MIMVS 治疗老年患者与术后并发症减少、输血减少、ICU 和住院时间缩短、体外循环和心肺转流时间延长有关。
