Huang Weimin, Hou Biao, Li Qin, Zhang Yuhai, Wang Liang
Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China.
Department of Cardiology, Baotou Central Hospital, Baotou, China.
J Card Surg. 2022 Jan;37(1):186-196. doi: 10.1111/jocs.16085. Epub 2021 Oct 17.
This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme.
The PubMed, EMBASE, the Cochrane Library, CNKI, and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery (3D-MVS), robot-assisted mitral valve surgery (R-MVS); totally thoracoscopic mitral valve surgery (T-MVS), small incision mitral valve surgery (M-MVS), and traditional thoracotomy mitral valve surgery (C-MVS). Stata16.0 and Addis1.16.8 software was used for network meta-analysis using the Bayesian approach.
A total of 31 studies were included, 12,998 patients, involving five surgical methods. Network meta-analysis showed that: in terms of complications (odds ratio [OR]: 0.65, 95% CI: 0.13-3.00, probability rank = 0.37) and MR (OR: 0.03, 95% CI: 0.0-8315, probability rank = 0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16-1.84, probability rank = 0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect.
This minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.
本研究采用网状Meta分析方法比较不同手术方法治疗成人二尖瓣反流（MR）的有效性，为临床选择最佳手术方案提供参考。
全面检索PubMed、EMBASE、Cochrane图书馆、CNKI和重庆维普资讯数据库至2020年12月。收集包括3D内镜二尖瓣手术（3D-MVS）、机器人辅助二尖瓣手术（R-MVS）、全胸腔镜二尖瓣手术（T-MVS）、小切口二尖瓣手术（M-MVS）和传统开胸二尖瓣手术（C-MVS）等手术方式的回顾性比较研究。使用Stata16.0和Addis1.16.8软件采用贝叶斯方法进行网状Meta分析。
共纳入31项研究，12998例患者，涉及五种手术方法。网状Meta分析显示：在并发症（比值比[OR]：0.65，95%可信区间[CI]：0.13 - 3.00，概率排名 = 0.37）和MR（OR：0.03，95%CI：0.0 - 8315，概率排名 = 0.64）方面，3D-MVS组事件发生率最低。在输血率（OR：0.55，95%CI：0.16 - 1.84，概率排名 = 0.45）方面，T-MVS事件发生率最低。此外，除手术时间和胸腔引流外，R-MVS组疗效最佳。
这种微创手术各有优缺点。总体而言，3D-MVS最令人满意，但需要更多样本。
