Claessens Jade, Rottiers Roxanne, Vandenbrande Jeroen, Gruyters Ine, Yilmaz Alaaddin, Kaya Abdullah, Stessel Björn
Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium.
Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, 3500 Hasselt, Belgium.
Indian J Thorac Cardiovasc Surg. 2023 Jul;39(4):367-380. doi: 10.1007/s12055-023-01501-y. Epub 2023 Apr 3.
Minimally invasive procedures have been developed to reduce surgical trauma after cardiac surgery. Clinical recovery is the main focus of most research. Still, patient-centred outcomes, such as the quality of life, can provide a more comprehensive understanding of the impact of the surgery on the patient's life. This systematic review aims to deliver a detailed summary of all available research investigating the quality of recovery, assessed with quality of life instruments, in adults undergoing minimally invasive cardiac surgery.
All randomised trials, cohort studies, and cross-sectional studies assessing the quality of recovery in patients undergoing minimally invasive cardiac surgery compared to conventional cardiac surgery within the last 20 years were included, and a summary was prepared.
The randomised trial observed an overall improved quality of life after both minimally invasive and conventional surgery. The quality of life improvement in the minimally invasive group showed a faster course and evolved to a higher level than the conventional surgery group. These findings align with the results of prospective cohort studies. In the cross-sectional studies, no significant difference in the quality of life was seen except for one that observed a significantly higher quality of life in the minimally invasive group.
This systematic review indicates that patients may benefit from minimally invasive and conventional cardiac surgery, but patients undergoing minimally invasive cardiac surgery may recover sooner and to a greater extent. However, no firm conclusion could be drawn due to the limited available studies. Therefore, randomised controlled trials are needed.
已开发出微创手术以减少心脏手术后的手术创伤。临床恢复是大多数研究的主要重点。然而,以患者为中心的结果,如生活质量,可以更全面地了解手术对患者生活的影响。本系统评价旨在详细总结所有可用的研究,这些研究使用生活质量工具评估接受微创心脏手术的成年人的恢复质量。
纳入过去20年内所有评估微创心脏手术患者与传统心脏手术患者恢复质量的随机试验、队列研究和横断面研究,并进行总结。
随机试验观察到微创和传统手术后患者的总体生活质量均有所改善。微创组的生活质量改善进程更快,且比传统手术组提升到更高水平。这些发现与前瞻性队列研究的结果一致。在横断面研究中,除一项研究观察到微创组的生活质量显著更高外,未发现生活质量有显著差异。
本系统评价表明,患者可能从微创和传统心脏手术中获益,但接受微创心脏手术的患者可能恢复得更快且程度更大。然而,由于现有研究有限,无法得出确凿结论。因此,需要进行随机对照试验。