Eranki Aditya, Muston Benjamin, Ng Dominic, Wilson-Smith Ashley R, Gupta Aashray K
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
School of Medicine and Surgery, University of New South Wales, Sydney, Australia.
Ann Cardiothorac Surg. 2024 Mar 29;13(2):117-125. doi: 10.21037/acs-2023-afm-20. Epub 2024 Mar 12.
Atrial fibrillation (AF) is the most common arrhythmia, and is also associated with mitral valve disease. Although the benefits of robotic mitral valve surgery are well documented, literature combining robotic mitral valve surgery with AF surgery remains sparse. The aim of this systematic review and meta-analysis is to evaluate the evidence assessing the efficacy and safety of AF ablation during robotic mitral valve surgery.
Five electronic databases were searched from inception to April 2023. All studies reporting the primary outcome, freedom from AF, for patients with a history of AF undergoing robotic mitral valve surgery and AF ablation were identified. Studies which included mixed cohorts, or patients who did not undergo robotic mitral valve surgery were excluded. Relevant data were extracted and a meta-analysis of proportions was conducted using a random-effects model.
Five studies were included with a total of 241 patients. Cohort sizes ranged from 11 to 94 patients. The aggregate mean age was 58.5 years and patients had persistent AF (71.1%). All five studies utilised the da Vinci Surgical System, and performed variable lesion sets. The freedom from AF was 88.1% at a weighted mean follow-up of 6.9 months. There were two mortalities (0.8%), two patients required conversion to sternotomy (1.4%) and eight required a permanent pacemaker (3.7%).
AF ablation with robotic mitral valve surgery can be performed with adequate short-term efficacy and safety profile. Current evidence on AF ablation and robotic mitral valve surgery is limited to low-quality retrospective data with inherent selection bias. Further large-scale prospective data is required to verify these results.
心房颤动（AF）是最常见的心律失常，且与二尖瓣疾病相关。尽管机器人二尖瓣手术的益处已有充分记录，但将机器人二尖瓣手术与房颤手术相结合的文献仍然稀少。本系统评价和荟萃分析的目的是评估评估机器人二尖瓣手术期间房颤消融疗效和安全性的证据。
检索了五个电子数据库，检索时间从建库至2023年4月。纳入所有报告接受机器人二尖瓣手术和房颤消融的房颤病史患者主要结局（无房颤）的研究。排除纳入混合队列或未接受机器人二尖瓣手术患者的研究。提取相关数据，并使用随机效应模型进行比例荟萃分析。
纳入五项研究，共241例患者。队列规模从11例至94例患者不等。总平均年龄为58.5岁，患者为持续性房颤（71.1%）。所有五项研究均使用达芬奇手术系统，并进行了不同的消融术式。在加权平均随访6.9个月时，无房颤率为88.1%。有两例死亡（0.8%），两例患者需要转为胸骨切开术（1.4%），八例需要植入永久起搏器（3.7%）。
机器人二尖瓣手术联合房颤消融术可获得足够的短期疗效和安全性。目前关于房颤消融和机器人二尖瓣手术的证据仅限于存在固有选择偏倚的低质量回顾性数据。需要进一步的大规模前瞻性数据来验证这些结果。
