Minimally Invasive Procedure versus Conventional Redo Sternotomy for Mitral Valve Surgery in Patients with Previous Cardiac Surgery: A Systematic Review and Meta-Analysis.

Q4 Medicine
Journal of Chest Surgery Pub Date : 2023-11-05 Epub Date: 2023-10-11 DOI:10.5090/jcs.23.038
Muhammad Ali Tariq, Minhail Khalid Malik, Qazi Shurjeel Uddin, Zahabia Altaf, Mariam Zafar
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引用次数: 0

Abstract

Background: The heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population.

Methods: We searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model.

Results: We included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37-0.80), length of hospital stay (MD, -4.23; 95% CI, -5.77 to -2.68), length of intensive care unit (ICU) stay (MD, -2.02; 95% CI, -3.17 to -0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05).

Conclusion: The current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.

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既往心脏手术患者二尖瓣手术的微创手术与传统重做立体术:系统综述和荟萃分析。
背景:与重复心脏手术相关的发病率和死亡率升高是有充分记录的。重做正中胸骨切开术(MS)和微创瓣膜手术是既往心脏手术需要二尖瓣手术(MVS)的患者的选择。我们进行了一项系统综述和荟萃分析,比较了该人群中重做MS和微创MVS(MIMVS)的结果。方法:我们在PubMed、EMBASE和Scopus上搜索比较redo-MS和MIMVS治疗MVS结果的研究。为了计算二元结果的风险比(RR)和连续数据的加权平均差(MD),我们采用了随机效应模型。结果:我们纳入了12项回顾性观察性研究,包括4157名参与者(675名为MIMVS;3482名为重做MS)。死亡率(RR,0.54;95%置信区间[CI],0.37-0.80)、住院时间(MD,-4.23;95%CI,-5.77至-2.68)、重症监护室(ICU)住院时间(马里兰州,-2.02;95%可信区间,-3.17至-0.88)和新发急性肾损伤(AKI)风险的降低(比值比,0.34;95%可信可信区间,0.19至0.61)具有统计学意义,有利于MIMVS(p0.05)。结论:目前的文献,主要由回顾性比较组成,强调了MIMVS相对于重做多发性硬化症的某些益处,包括降低死亡率、缩短住院时间和ICU住院时间,以及降低AKI风险。鉴于缺乏高质量的证据,有必要进行具有足够力量的前瞻性随机对照试验来研究长期结果。
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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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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