570470 Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano, Plano, TX, USA.
Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
Innovations (Phila). 2021 May-Jun;16(3):244-248. doi: 10.1177/1556984521997086. Epub 2021 Apr 8.
The scope of application of minimally invasive mitral valve surgery is expanding. However, the safety and efficacy of minimally invasive mitral valve surgery in the setting of infective endocarditis is not well known. We sought to identify the best evidence available to support a minimally invasive surgical approach for mitral valve infective endocarditis.
A systematic review of minimally invasive mitral valve surgery for infective endocarditis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
A total of 6 manuscripts describing 271 patients were identified. Mean age was 60.4 ± 14.9 years old, and 60.1% patients were male. Mean EuroSCORE II was 24.6 ± 23.2. Mitral valve repair was achieved in 32.4% of cases. The average in-hospital mortality was 9.4%, and average length of hospital stay was 21.6 days. Survival was 89.1% at 30 days, and 1-year survival was 79.3%. Rate of conversion to sternotomy was 1.8%. Postoperative complications included: 6.9% postoperative bleeding, 9.3% new postoperative dialysis, 2.3% postoperative stroke, and 3.4% recurrence of endocarditis. Reoperation over the long-term was required in 9.3% of cases.
Minimally invasive mitral valve surgery for infective endocarditis has acceptable perioperative morbidity as well as short- and intermediate-term mortality at experienced centers. Minimally invasive mitral valve surgery may be an acceptable alternative approach to infective endocarditis and warrants further study.
微创二尖瓣手术的应用范围正在扩大。然而，感染性心内膜炎微创二尖瓣手术的安全性和疗效尚不清楚。我们旨在确定支持感染性心内膜炎微创外科手术的最佳证据。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对微创二尖瓣手术治疗感染性心内膜炎进行了系统评价。
共确定了 6 篇描述 271 例患者的文献。平均年龄为 60.4±14.9 岁，60.1%的患者为男性。平均 EuroSCORE II 为 24.6±23.2。32.4%的病例实现了二尖瓣修复。住院死亡率平均为 9.4%，平均住院时间为 21.6 天。30 天生存率为 89.1%，1 年生存率为 79.3%。转为正中开胸的比例为 1.8%。术后并发症包括：术后出血 6.9%，术后新透析 9.3%，术后中风 2.3%，心内膜炎复发 3.4%。长期需要再次手术的比例为 9.3%。
在经验丰富的中心，微创二尖瓣手术治疗感染性心内膜炎具有可接受的围手术期发病率和短期及中期死亡率。微创二尖瓣手术可能是感染性心内膜炎的一种可接受的替代方法，值得进一步研究。
