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

Muhammad Ali Tariq; Minhail Khalid Malik; Qazi Shurjeel Uddin; Zahabia Altaf; Mariam Zafar

doi:10.5090/jcs.23.038

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

Journal of chest surgery, v.56 no.6, 2023년, pp.374 - 386

Muhammad Ali Tariq (Department of Surgery, Dow University Hospital, Dow University of Health Sciences) , Minhail Khalid Malik (Department of Surgery, Dow University Hospital, Dow University of Health Sciences) , Qazi Shurjeel Uddin (Department of Surgery, Dow Medical College, Dow University of Health Sciences) , Zahabia Altaf (Department of Surgery, Dow Medical College, Dow University of Health Sciences) , Mariam Zafar (Department of Surgery, Dow Medical College, Dow University of Health Sciences)

Abstract ▼ AI-Helper

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 (p0.05). 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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표/그림 (10)

그림 Fig. 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow diagram summarizing the process used to select relevant clinical studies.
표 Table 1. Baseline characteristics of included studies
표 Table 2. Additional data of interest from individual studies
그림 Fig. 2. Forest plot illustrating risk of mortality. CI, confidence interval; REML, restricted maximum likelihood.
그림 Fig. 3. Forest plot depicting length of hospital stay (days). SD, standard deviation; CI, confidence interval; REML, restricted maximum likelihood.
그림 Fig. 4. Forest plot illustrating risk of stroke. CI, confidence interval; REML, restricted maximum likelihood.
그림 Fig. 5. Forest plot showing length of intensive care unit (ICU) stay (days). SD, standard deviation; CI, confidence interval; REML, restricted maximum likelihood.
그림 Fig. 6. (A) Forest plot illustrating risk of acute kidney injury requiring dialysis. (B) Forest plot depicting risk of new-onset atrial fibrillation. (C) Forest plot depicting risk of reoperation for bleeding. (D) Forest plot illustrating risk of surgical site infection (SSI). (E) Forest plot of cross-clamp time (min). (F) Forest plot of cardiopulmonary bypass time (min). (G) Forest plot illustrating volume of blood loss (mL). SD, standard deviation; CI, confidence interval; REML, restricted maximum likelihood. (Continued on next page.)
그림 Fig. 6. (Continued; caption shown on previous page).
그림 Fig. 7. Funnel plot reflecting assessment of publication bias. (A) Bleeding. (B) Cardiopulmonary bypass time. (C) Hospital stay. (D) Mortality. (E) Stroke. CI, confidence interval.

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