Sajad Hussain, Alexander G Swystun, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra
{"title":"对传统胸骨切开术与微创二尖瓣手术治疗退行性二尖瓣疾病的回顾和荟萃分析集中于过去十年的证据。","authors":"Sajad Hussain, Alexander G Swystun, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra","doi":"10.1177/02676591231174579","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection.</p><p><strong>Methods: </strong>A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data.</p><p><strong>Results: </strong>MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, <i>p</i> < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, <i>p</i> < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, <i>p</i> = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, <i>p</i> < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, <i>p</i> < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A review and meta-analysis of conventional sternotomy versus minimally invasive mitral valve surgery for degenerative mitral valve disease focused on the last decade of evidence.\",\"authors\":\"Sajad Hussain, Alexander G Swystun, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra\",\"doi\":\"10.1177/02676591231174579\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection.</p><p><strong>Methods: </strong>A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data.</p><p><strong>Results: </strong>MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, <i>p</i> < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, <i>p</i> < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, <i>p</i> = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, <i>p</i> < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, <i>p</i> < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.</p>\",\"PeriodicalId\":49707,\"journal\":{\"name\":\"Perfusion-Uk\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perfusion-Uk\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/02676591231174579\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/5/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perfusion-Uk","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/02676591231174579","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/5/5 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的:早期荟萃分析比较了微创二尖瓣手术(MIMVS)和传统胸骨切开术(CS),确定了微创二尖瓣手术的安全性。我们对 2014 年以来的研究进行了回顾和荟萃分析,以研究 MIMVS 和 CS 在结果上的差异。具体而言,我们关注的一些结果包括肾衰竭、新发房颤、死亡率、中风、因出血再次手术、输血和肺部感染:方法:在六个数据库中对 MIMVS 与 CS 的比较研究进行了系统检索。尽管初步检索共发现了 821 篇论文,但有 9 项研究适合进行最终分析。所有纳入的研究都对 CS 与 MIMVS 进行了比较。由于使用了反方差和随机效应,因此选择了 Mantel - Haenszel 统计方法。对数据进行了荟萃分析:MIMVS明显降低了肾衰竭(OR:0.52;95% CI 0.37 至 0.73,p < 0.001)、新发心房颤动(OR:0.78;95% CI 0.67 至 0.90,p < 0.001)、延长插管时间(OR:0.50;95% CI 0.29 至 0.87,p = 0.01)和死亡率(OR:0.58;95% CI 0.38 至 0.87,p < 0.01)的几率。MIMVS的ICU住院时间更短(WMD:-0.42;95% CI -0.59至-0.24,p <0.001),出院时间更短(WMD:-2.79;95% CI -3.86至-1.71,p <0.001):结论:在现代社会,与 CS 相比,MIMVS 治疗退行性疾病可改善短期疗效。
A review and meta-analysis of conventional sternotomy versus minimally invasive mitral valve surgery for degenerative mitral valve disease focused on the last decade of evidence.
Objectives: Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection.
Methods: A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data.
Results: MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, p < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, p < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, p = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, p < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, p < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, p < 0.001).
Conclusion: In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.
期刊介绍:
Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.