Servito Maria, Ramsay Hannah, Mann Sarah, Ramelli Luca, Fernandez Angel-Luis, Diasty Mohammad El
Division of Cardiac Surgery, University of Manitoba, Winnipeg, MB, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto, ON, Canada.
Innovations (Phila). 2025 May-Jun;20(3):257-264. doi: 10.1177/15569845251335969. Epub 2025 May 13.
Whether minimally invasive aortic valve replacement (MIAVR) offers an advantage over conventional AVR (CAVR) remains a matter of debate. Although some studies have suggested better postoperative outcomes with MIAVR, technical challenges and longer operative times remain major obstacles to the adoption of these techniques. In this meta-analysis, we compare the reported immediate postoperative outcomes of both approaches.
Cochrane, MEDLINE, and Embase databases were searched from inception until January 2022 for studies reporting immediate postoperative outcomes of MIAVR and CAVR. Studies were excluded if they reported on concomitant procedures or enrolled pediatric patients. Random-effects meta-analysis was performed using the restricted maximum likelihood estimator with Hartung-Knapp adjustment.
The literature search yielded 3,921 articles, of which 75 were included in this meta-analysis. The most common techniques were ministernotomy and minithoracotomy. MIAVR was associated with lower 30-day mortality than CAVR (odds ratio [OR] = 0.65, 95% confidence interval [CI]: 0.54 to 0.78, I = 0%, < 0.001). The length of stay (LOS) in the hospital (standardized mean difference [SMD] = -0.44, 95% CI: -0.61 to -0.26, < 0.001) and in the intensive care unit (SMD = -0.36, 95% CI: -0.57 to -0.15, < 0.001) were shorter for MIAVR. Individual comparisons of ministernotomy and minithoracotomy to CAVR also yielded similar results. However, aortic cross-clamping and cardiopulmonary bypass times were longer for MIAVR.
Our meta-analysis suggests that minimally invasive approaches to AVR may provide advantages beyond cosmesis. Despite longer operative times, MIAVR was associated with earlier recovery and shorter hospital LOS. These findings were consistent for both minithoracotomy and ministernotomy.
微创主动脉瓣置换术（MIAVR）是否比传统主动脉瓣置换术（CAVR）更具优势仍存在争议。尽管一些研究表明MIAVR术后效果更好，但技术挑战和更长的手术时间仍是采用这些技术的主要障碍。在这项荟萃分析中，我们比较了两种手术方式术后即刻的报道结果。
检索Cochrane、MEDLINE和Embase数据库，从数据库建立至2022年1月，查找报道MIAVR和CAVR术后即刻结果的研究。如果研究报道了同期手术或纳入了儿科患者，则将其排除。使用带有Hartung-Knapp调整的受限最大似然估计器进行随机效应荟萃分析。
文献检索共获得3921篇文章，其中75篇纳入了本荟萃分析。最常用的技术是胸骨上段小切口和胸腔镜小切口。MIAVR与CAVR相比，30天死亡率更低（比值比[OR]=0.65，95%置信区间[CI]：0.54至0.78，I²=0%，P<0.001）。MIAVR的住院时间（标准化均数差[SMD]=-0.44，95%CI：-0.61至-0.26，P<0.001）和重症监护病房住院时间（SMD=-0.36，95%CI：-0.57至-0.15，P<0.001）更短。胸骨上段小切口和胸腔镜小切口与CAVR的个体比较也得出了类似结果。然而，MIAVR的主动脉阻断时间和体外循环时间更长。
我们的荟萃分析表明，AVR的微创方法可能除了美观之外还具有其他优势。尽管手术时间更长，但MIAVR与更早恢复和更短的住院时间相关。这些结果在胸腔镜小切口和胸骨上段小切口手术中均一致。
