El-Andari Ryaan, Fialka Nicholas M, Shan Shubham, White Abigail, Manikala Vinod K, Wang Shaohua
From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Cardiol Rev. 2024;32(3):217-242. doi: 10.1097/CRD.0000000000000488. Epub 2022 Dec 28.
In recent years, minimally invasive cardiac surgery has increased in prevalence. There has been significant debate regarding the optimal approach to isolated aortic valve replacement between conventional midline sternotomy and minimally invasive approaches. We performed a systematic review of the contemporary literature comparing minimally invasive to full sternotomy aortic valve replacement. PubMed and Embase were systematically searched for articles published from 2010-2021. A total of 1215 studies were screened and 45 studies (148,606 patients total) met the inclusion criteria. This study found rates of in-hospital mortality were higher with full sternotomy than ministernotomy ( P = 0.02). 30-day mortality was higher with full sternotomy compared to right anterior thoracotomy ( P = 0.006). Renal complications were more common with full sternotomy versus ministernotomy ( P < 0.00001) and right anterior thoracotomy ( P < 0.0001). Rates of wound infections were greater with full sternotomy than ministernotomy ( P = 0.02) and right anterior thoracotomy ( P < 0.00001). Intensive care unit length of stay ( P = 0.0001) and hospital length of stay ( P < 0.0001) were shorter with ministernotomy compared to full sternotomy. This review found that minimally invasive approaches to isolated aortic valve replacement result in reduced early mortality and select measures of postoperative morbidity; however, long-term mortality is not significantly different based on surgical approach. An analysis of mortality alone is not sufficient for the selection of the optimal approach to isolated aortic valve replacement. Surgeon experience, individual patient characteristics, and preference require thorough consideration, and additional studies investigating quality of life measures will be imperative in identifying the optimal approach to isolated aortic valve replacement.
近年来，微创心脏手术的普及率有所上升。在传统正中胸骨切开术和微创方法之间，关于单纯主动脉瓣置换的最佳方法存在重大争议。我们对当代文献进行了系统回顾，比较了微创与全胸骨切开主动脉瓣置换术。系统检索了PubMed和Embase中2010年至2021年发表的文章。共筛选了1215项研究，45项研究（共148,606例患者）符合纳入标准。本研究发现，全胸骨切开术的院内死亡率高于小切口胸骨切开术（P = 0.02）。与右前外侧开胸术相比，全胸骨切开术的30天死亡率更高（P = 0.006）。与小切口胸骨切开术（P < 0.00001）和右前外侧开胸术（P < 0.0001）相比，全胸骨切开术的肾脏并发症更常见。全胸骨切开术的伤口感染率高于小切口胸骨切开术（P = 0.02）和右前外侧开胸术（P < 0.00001）。与全胸骨切开术相比，小切口胸骨切开术的重症监护病房住院时间（P = 0.0001）和住院时间（P < 0.0001）更短。本综述发现，单纯主动脉瓣置换的微创方法可降低早期死亡率和部分术后发病率指标；然而，基于手术方式的长期死亡率并无显著差异。仅分析死亡率不足以选择单纯主动脉瓣置换的最佳方法。外科医生的经验、个体患者特征和偏好需要全面考虑，并且进一步研究生活质量指标对于确定单纯主动脉瓣置换的最佳方法至关重要。
