Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada.
Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
J Card Surg. 2022 May;37(5):1319-1327. doi: 10.1111/jocs.16314. Epub 2022 Feb 16.
Whether minimally invasive mitral valve surgery (MMVS) leads to better outcomes remains unclear. We conducted a systematic review and meta-analysis comparing various MMVS approaches with conventional sternotomy.
We searched Cochrane CENTRAL, MEDLINE, EMBASE, ClinicalTrials. gov, and the ISRCTN Register for studies comparing minimally invasive approach (thoracotomy, port access, partial sternotomy, or robotic) with median sternotomy for mitral valve surgery. We performed title and abstract, full-text screening, and data extraction independently and in duplicate. We pooled data using random effect models. Quality assessment was performed using validated tools. Certainty of evidence was established using the GRADE framework.
One hundred and nineteen studies (n = 38,106) met eligibility criteria: eight randomized controlled trials (RCTs) and 111 observational studies. MMVS was associated with fewer days in hospital (RCT: MD: -2.2 days, 95% CI, [-3.7 to -0.8]; observational: MD: -2.4 days, 95% CI, [-2.7 to -2.1]). Observational studies suggested that MMVS reduced transfusion requirements with fewer units transfused per patient (MD: -1.2; 95% CI, [-1.6 to -0.9]) and fewer patients transfused (RR, 0.7; 95% CI, [0.6-0.7]). Observational data also suggested lower mortality with MMVS (RR, 0.6; 95% CI, [0.5-0.7], p < .001, I = 0%), but this was not corroborated by RCT data. The risk of postoperative mitral regurgitation (≥2+ or requiring re-intervention) did not differ between the two groups.
MMVS may be associated with shorter length of hospital stay with no significant difference in short-term morbidity and mortality. There is a paucity of high-quality data on the long-term outcomes of MMVS when compared with conventional sternotomy.
微创二尖瓣手术（MMVS）是否能带来更好的结果仍不清楚。我们进行了一项系统评价和荟萃分析，比较了各种微创方法与传统胸骨切开术。
我们检索了 Cochrane 中心、MEDLINE、EMBASE、ClinicalTrials.gov 和 ISRCTN 登记处，以比较微创方法（开胸、端口接入、部分胸骨切开术或机器人）与正中胸骨切开术治疗二尖瓣手术的研究。我们独立地进行了标题和摘要、全文筛选和数据提取，并进行了重复筛选。我们使用随机效应模型汇总数据。使用经过验证的工具进行质量评估。使用 GRADE 框架确定证据的确定性。
有 119 项研究（n=38106）符合入选标准：8 项随机对照试验（RCT）和 111 项观察性研究。MMVS 与住院天数减少相关（RCT：MD：-2.2 天，95%CI：[-3.7 至-0.8]；观察性研究：MD：-2.4 天，95%CI：[-2.7 至-2.1]）。观察性研究表明，MMVS 减少了输血需求，每位患者输血量减少（MD：-1.2；95%CI：[-1.6 至-0.9]），需要输血的患者减少（RR，0.7；95%CI：[0.6-0.7]）。观察性数据还表明 MMVS 死亡率较低（RR，0.6；95%CI：[0.5-0.7]，p<0.001，I ²=0%），但 RCT 数据并未证实这一点。两组术后二尖瓣反流（≥2+或需要再次干预）的风险无差异。
MMVS 可能与较短的住院时间相关，且短期发病率和死亡率无显著差异。与传统胸骨切开术相比，MMVS 的长期结果数据质量较低。
