Minimally invasive approaches versus conventional sternotomy for aortic valve replacement in patients with aortic valve disease: a systematic review and meta-analysis of 17,269 patients

Saad Khalid, Muhammad Hassan, Abraish Ali, Farah Anwar, M. Siddiqui, Sunita Shrestha
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Abstract

Aortic valve replacement (AVR) is a common procedure for aortic valve pathologies, particularly in the elderly. While traditional open AVR is established, minimally invasive techniques aim to reduce morbidity and enhance treatment outcomes. Our meta-analysis compares these approaches with conventional sternotomy, offering insights into short and long-term mortality and postoperative results. This study provides valuable evidence for informed decision-making between conventional and minimally invasive approaches for AVR. Till august 2023, PubMed, Embase, and MEDLINE databases were searched for Randomized controlled trials (RCT) and propensity score matched (PSM) studies comparing minimally invasive approaches [mini-sternotomy (MS) and right mini thoracotomy (RMT)] with full sternotomy (FS) for AVR. Various outcomes were analyzed, including mortality rates, bypass and clamp times, length of hospital stay, and complications. Risk ratios (RR) and the weighted mean differences (WMD) with corresponding 95% confidence intervals were calculated using Review Manager. Forty-eight studies were included having 17,269 patients in total. When compared to FS, there was no statistically significant difference in in-hospital mortality in MS (RR:0.80; 95%CI:0.50 to 1.27; I2=1%; P=0.42) and RMT (RR:0.70; 95%CI:0.36 to 1.35; I2=0%; P=0.29). FS was also linked with considerably longer cardiopulmonary bypass duration than MS (MD:8.68; 95%CI:5.81 to 11.56; I2=92%; P=0.00001). The hospital length of stay was determined to be shorter in MS (MD:−0.58; 95%CI:−1.08 to −0.09; I2=89%; P=0.02) with no statistically significant difference in RMT (MD:−0.67; 95%CI:−1.42 to 0.08; I2=84%; P=0.08) when compared to FS. While mortality rates were comparable in minimally invasive approaches and FS, analysis shows that MS, due to fewer respiratory and renal insufficiencies, as well as shorter hospital and ICU stay, may be a safer approach than both RMT and FS.
主动脉瓣疾病患者主动脉瓣置换术的微创方法与传统胸骨切开术:对 17,269 例患者的系统回顾和荟萃分析
主动脉瓣置换术(AVR)是治疗主动脉瓣病变的常见手术,尤其适用于老年人。虽然传统的开放式主动脉瓣置换术已经确立,但微创技术旨在降低发病率并提高治疗效果。我们的荟萃分析将这些方法与传统的胸骨切开术进行了比较,对短期和长期死亡率及术后效果进行了深入分析。这项研究为在传统和微创方法之间做出明智的房室重建决策提供了宝贵的证据。 截至 2023 年 8 月,我们在 PubMed、Embase 和 MEDLINE 数据库中检索了随机对照试验 (RCT) 和倾向评分匹配 (PSM) 研究,比较了微创方法(迷你胸廓切开术 (MS) 和右迷你胸廓切开术 (RMT))与全胸骨切开术 (FS) 在 AVR 中的应用。对各种结果进行了分析,包括死亡率、分流和钳夹时间、住院时间和并发症。使用Review Manager计算风险比(RR)和加权平均差(WMD)以及相应的95%置信区间。 共纳入48项研究,涉及17269名患者。与 FS 相比,MS(RR:0.80;95%CI:0.50 至 1.27;I2=1%;P=0.42)和 RMT(RR:0.70;95%CI:0.36 至 1.35;I2=0%;P=0.29)的院内死亡率无显著统计学差异。与 MS 相比,FS 的心肺旁路持续时间更长(MD:8.68; 95%CI:5.81 to 11.56; I2=92%; P=0.00001)。与 FS 相比,MS 的住院时间更短(MD:-0.58; 95%CI:-1.08 to -0.09; I2=89%; P=0.02),而 RMT 的住院时间无显著统计学差异(MD:-0.67; 95%CI:-1.42 to 0.08; I2=84%; P=0.08)。 虽然微创方法和 FS 的死亡率相当,但分析表明,MS 由于减少了呼吸和肾功能不全,缩短了住院时间和重症监护室停留时间,可能是比 RMT 和 FS 更安全的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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