Amin Aamir, Kumar Rajanikant, Mokhtassi Shiva Seyed, Alassiri Abdullah K, Odaman Agatha, Khan Muhammad Ahmad Raza, Lakshmana Shashi, Din Zahir Ud, Acharya Pawan, Cheema Huzaifa Ahmad, Nashwan Abdulqadir J, Khan Arsalan Ali, Hussain Awab, Bhudia Sunil, Vincent Royce P
Department of Cardiothoracic Surgery, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Cardiothoracic and Vascular Surgery, Jay Prabha Medanta Super Specialty Hospital, Patna, India.
Front Cardiovasc Med. 2024 Aug 12;11:1437524. doi: 10.3389/fcvm.2024.1437524. eCollection 2024.
The evidence underlying the efficacy and safety of minimally invasive mitral valve surgery (MIMVS) is inconclusive. We conducted a meta-analysis to evaluate whether MIMVS improves clinical outcomes compared with conventional sternotomy.
We searched MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov from inception to January 2024 for all randomised controlled trials (RCTs), comparing MIMVS with conventional mitral valve surgery. RevMan 5.4 was used to analyse the data with risk ratio (RR) and mean difference (MD) as the effect measures.
Eight studies reporting data on 7 RCTs were included in our review. There was no significant difference in all-cause mortality, the number of patients requiring blood product transfusion, and the change from baseline in the SF-36 physical function scores between the MIMVS and conventional sternotomy groups. MIMVS reduced the length of hospital stay (MD -2.02 days, 95% CI: -3.66, -0.39) but did not affect the length of ICU stay, re-operation for bleeding, and the incidence of renal injury, wound infection, neurological events, and postoperative moderate or severe mitral regurgitation. MIMVS was associated with a trend toward lower postoperative pain scores (MD -1.06; 95% CI: -3.96 to 0.75).
MIMVS reduced the number of days spent in the hospital and showed a trend toward lower postoperative pain scores, but it did not decrease the risk of all-cause mortality or the number of patients needing blood product transfusions. Further large-scale RCTs are required to inform definitive conclusions, particularly with regard to quality-of-life outcomes investigating functional recovery.
PROSPERO (CRD42023482122).
微创二尖瓣手术（MIMVS）疗效和安全性的相关证据尚无定论。我们进行了一项荟萃分析，以评估与传统胸骨切开术相比，MIMVS是否能改善临床结局。
我们检索了从数据库建立至2024年1月的MEDLINE（通过PubMed）、Embase、Cochrane图书馆和ClinicalTrials.gov，查找所有比较MIMVS与传统二尖瓣手术的随机对照试验（RCT）。使用RevMan 5.4对数据进行分析，效应量采用风险比（RR）和均值差（MD）。
我们的综述纳入了8项报告7项RCT数据的研究。MIMVS组和传统胸骨切开术组在全因死亡率、需要输血的患者数量以及SF - 36身体功能评分相对于基线的变化方面均无显著差异。MIMVS缩短了住院时间（MD -2.02天，95%CI：-3.66，-0.39），但不影响重症监护病房住院时间、因出血再次手术以及肾损伤、伤口感染、神经事件和术后中度或重度二尖瓣反流的发生率。MIMVS术后疼痛评分有降低趋势（MD -1.06；95%CI：-3.96至0.75）。
MIMVS减少了住院天数，术后疼痛评分有降低趋势，但并未降低全因死亡率风险或需要输血的患者数量。需要进一步开展大规模RCT以得出明确结论，特别是在调查功能恢复的生活质量结局方面。
PROSPERO（CRD42023482122）。
