Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia.
Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia.
Asian J Surg. 2024 Jan;47(1):35-42. doi: 10.1016/j.asjsur.2023.09.001. Epub 2023 Sep 11.
A minimally invasive approach through right mini-thoracotomy for redo mitral valve surgery may improve patients' outcomes compared to median sternotomy. This study aims to evaluate the outcomes of both procedures according to the Mitral Valve Academic Research Consortium (MVARC). This systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Literature searching was performed in several databases including PubMed, EBSCOhost, Scopus, and Proquest up to 28 February 2022. Meta-analysis using proportions or means was applied. A total of 13 retrospective cohort articles were included in this study. The incidence of in-hospital mortality (3% vs 9.2%, OR = 0.35; 95% CI: 0.21-0.58; P ≤ 0.0001), reintervention for bleeding (3.8% vs 5.9%, OR = 0.56; 95% CI: 0.32-0.97; P = 0.04), and acute renal failure (5% vs 12%, OR = 0.29; 95% CI: 0.23-0.65; P = 0.0003) was significantly lower in mini-thoracotomy (MINI) group compared to median sternotomy (STER) group. The incidence of neurologic events (3.4% vs 5.5%, OR = 0.66; 95% CI: 0.4-1.08; P = 0.1) and arrhythmia (19.5% vs 25.5%, OR = 0.64; 95% CI: 0.38-1.09; P = 0.1) were also lower in MINI group compared to STER group but was not significant statistically. No significant differences were found in myocardial infarct (1% vs 1%, OR = 0.71; 95% CI: 0.06-8.85; P = 0.79) between MINI and STER group. A minimally invasive surgery through right mini-thoracotomy is associated with a lower incidence of in-hospital mortality, reintervention for bleeding, and acute renal failure. It is a safe alternative to median sternotomy for redo mitral valve surgery.
经右小切口微创入路行二尖瓣再次手术可能优于正中开胸术改善患者预后。本研究旨在根据二尖瓣学术研究联盟 (MVARC) 评估两种手术的结果。本系统评价和荟萃分析符合系统评价和荟萃分析的首选报告项目 (PRISMA)。文献检索在包括 PubMed、EBSCOhost、Scopus 和 Proquest 在内的多个数据库中进行，截至 2022 年 2 月 28 日。应用比例或平均值进行荟萃分析。本研究共纳入 13 篇回顾性队列文章。住院死亡率（3%比 9.2%，OR=0.35；95%CI：0.21-0.58；P≤0.0001）、出血再干预（3.8%比 5.9%，OR=0.56；95%CI：0.32-0.97；P=0.04）和急性肾功能衰竭（5%比 12%，OR=0.29；95%CI：0.23-0.65；P=0.0003）的发生率明显低于小切口（MINI）组。与正中开胸（STER）组相比，MINI 组的神经系统事件（3.4%比 5.5%，OR=0.66；95%CI：0.4-1.08；P=0.1）和心律失常（19.5%比 25.5%，OR=0.64；95%CI：0.38-1.09；P=0.1）的发生率也较低，但无统计学意义。MINI 组和 STER 组心肌梗死发生率（1%比 1%，OR=0.71；95%CI：0.06-8.85；P=0.79）无显著差异。经右小切口微创入路可降低住院死亡率、出血再干预和急性肾功能衰竭的发生率。它是二尖瓣再次手术的一种安全的正中开胸术替代方法。
