二尖瓣手术同期行房颤外科消融的微创与传统胸骨切开术：一项比较性系统评价
Minimally Invasive or Conventional Sternotomy for Mitral Valve Surgery With Concomitant Surgical Ablation for Atrial Fibrillation: A Comparative Systematic Review.
作者信息
Kashapov Robert, Afanasyev Alexander, Sharifulin Ravil, Khrushchev Sergey, Ruzankin Pavel, Demin Igor, Bogachev-Prokophiev Alexander
机构信息
E. Meshalkin National Medical Research Center, Institute of Cardiovascular Pathology Research, 630055 Novosibirsk, Russian Federation.
Sobolev Institute of Mathematics, 630090 Novosibirsk, Russian Federation.
出版信息
Rev Cardiovasc Med. 2025 Aug 21;26(8):39706. doi: 10.31083/RCM39706. eCollection 2025 Aug.
BACKGROUND
Presently, the availability of single-stage surgical correction of mitral valve disease combined with atrial fibrillation (AF) via a mini-access approach remains limited. Moreover, the comparative effectiveness of this procedure versus conventional sternotomy (CS) remains poorly understood. Thus, this study aimed to conduct a comparative assessment of the efficacy and safety of concomitant mitral valve surgery and AF ablation via a minimally invasive approach (minimally invasive cardiac surgery, MICS group) versus the standard sternotomy approach (CS group).
METHODS
An extensive literature search was performed to identify relevant studies. Additionally, for comparative analysis, we included isolated studies where the combined intervention was conducted exclusively via either minimally invasive or CS as the primary access.
RESULTS
Freedom from atrial arrhythmia (AA) for MICS and CS was 94.52% [95% CI 91.52, 96.50] vs. 80.76% [95% CI 67.19, 89.59] and 86.22% [95% CI 80.13, 90.66] vs. 86.33% [95% CI 79.39, 91.19] at 1 and 2 years, respectively, with no statistically significant differences. Meanwhile, cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times were significantly longer in the MICS group compared to CS (CPB: 151.50 vs. 120.01 min; ACC: 112.36 vs. 101.43 min; < 0.001). There were no differences in mortality between groups ( = 0.709). The rate of pacemaker implantation was significantly higher in the CS group (MICS: 3.32% [95% CI 1.58, 6.87] vs. CS: 5.20% [95% CI 2.80, 9.46]; < 0.001).
CONCLUSION
This meta-analysis found that the minimally invasive approach was associated with longer CPB and ACC times but a lower rate of pacemaker implantation, with no significant differences observed in mortality and freedom from AA at 1 and 2 years.
THE PROSPERO REGISTRATION
CRD42024570022, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024570022.
背景
目前，通过微创入路对二尖瓣疾病合并心房颤动（AF）进行单阶段手术矫正的可行性仍然有限。此外，该手术与传统胸骨切开术（CS）相比的相对有效性仍知之甚少。因此，本研究旨在对通过微创入路（微创心脏手术，MICS组）与标准胸骨切开术入路（CS组）同期进行二尖瓣手术和AF消融的疗效和安全性进行比较评估。
方法
进行了广泛的文献检索以确定相关研究。此外，为了进行比较分析，我们纳入了仅通过微创或CS作为主要入路进行联合干预的单独研究。
结果
MICS组和CS组在1年和2年时的无房性心律失常（AA）率分别为94.52%[95%CI 91.52,96.50]对80.76%[95%CI 67.19,89.59]和86.22%[95%CI 80.13,90.66]对86.33%[95%CI 79.39,91.19]，无统计学显著差异。同时，MICS组的体外循环（CPB）和主动脉阻断（ACC）时间明显长于CS组（CPB：151.50对120.01分钟；ACC：112.36对101.43分钟；<0.001）。两组之间的死亡率无差异（=0.709）。CS组的起搏器植入率明显更高（MICS：3.32%[95%CI 1.58,6.87]对CS：5.20%[95%CI 2.80,9.46]；<0.001）。
结论
这项荟萃分析发现，微创入路与更长的CPB和ACC时间相关，但起搏器植入率较低，1年和2年时的死亡率和无AA率无显著差异。
PROSPERO注册号：CRD42024570022，https://www.crd.york.ac.uk/PROSPERO/view/CRD42024570022。
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