A Meta Analysis Of Thoracoscopic Assisted And Median Thoracotomy For Mitral Valvuloplasty

Objective:Evidence-based medicine was used to systematically evaluate the clinical evidence of video-assisted minimally invasive mitral valvuloplasty and traditional midthoracotomy mitral valvuloplasty,so as to supply reference for mitral valve surgery.Methods:Through searching foreign databases PubMed,Embase,Cochrane Library,Chinese biomedical literature,medical literature published by VIP,CNKI,Wanfangzhong from January 2000 to December 2020,comparing the curative effects of thoracoscopic minimally invasive mitral valvuloplasty with traditional median sternotomy mitral valvuloplasty,and carefully screening the retrieved literature,evaluating the quality and collecting the required data according to the established relevant standards,and using Rev Man5.3 to performe Meta-analysis.Results:One thousand and twenty-four patients suffered from mitral valve disease were collected in six articles,which covering five hundred and three in the endoscopic group and five hundred and twenty-one in the open-chest group.Meta-analysis revealed that:Comparing the operative time [MD=0.14,95%CI(-33.79,34.08),P=0.99] and aortic occlusion time [MD=13.30,95%CI(0.11,26.49),P=0.05] between the endoscopic group and the thoracotomy group were not found differentia.Although the endoscopic group had longer extracorporeal circulation time [MD=17.89,95%CI(1.32,34.46),P=0.03],it also had lower intraoperative blood loss [MD=-140.31,95%CI(-190.49,-90.13),P <0.00001],ICU residence time [MD=-11.34,95%CI(-16.09,-6.59),P < 0.00001],ventilator assist time [MD=-3.74,95%CI(-6.04,-1.44),P=0.001],postoperative drainage volume [MD=-121.16,95%CI(-135.12,-107.20),P < 0.00001],incidence of postoperative complications [OR=0.22,95%CI(0.14,0.33).P < 0.00001],pain score[MD=-2.82,95%CI(-5.22,-0.42),P=0.02] and perioperative probability of blood transfusion [OR=0.18,95%CI(0.10,0.34),P < 0.00001] than the thoracotomy group.Conclusion:Although thoracoscope assisted minimally invasive mitral valve plasty in extracorporeal circulation time than traditional slightly prolong median thoracotomy mitral aluloplasty(PM),but both in operation time,and there is no obvious difference of aorta blocking time and thoracoscope assisted minimally invasive mitral valve plasty in intraoperative blood loss,ICU time,ventilator assisted time,postoperative drainage volume,postoperative complication rate,pain score and perioperative blood transfusion rate were superior to the traditional open heart surgery.