Efficacy of totally thorascopic and median sternotomy approaches for mitral valve replacement:A meta analysis

doi:10.3969/j.issn.1672-5301.2017.10.018

Abstract：Objective To systematically review the efficacy of totally thorascopic and median sternotomy approaches for mitral valve replacement (MVR).Methods Databases including the Cochrane Library (Issue5,2016),PubMed,EMbase,CBM,CNKI,WanFang Data and VIP were searched electronically from their inception to October 2016.All RCT and cohort studies about the efficacy of totally thorascopic and median sternotomy approaches for MVR were analyzed.Two reviewers identified the literature independently according to inclusion and exclusion criteria.After data extraction and quality assessment of the included studies,meta-analysis was performed using RevMan 5.2 software.Results Eventually 6 cohort studies were enrolled,a total of 608 cases of patients,including thorascopic group(test group) 270 cases,sternotomy group(control group) 338 cases.The results of the meta-analysis showed that:Totally Thorascopic group postoperative ventilation time (MD=-1.82,95％CI -3.38--0.26,P=0.02),hospital stay time(MD=-3.50,95％CI-6.04--0.95,P=0.007) were significantly shorter than in the Median Sternotomy group,postoperative drainage (MD=-99.40,95％CI-181.30--17.50,P=0.02) were also less than in the Median Sternotomy group,but the aortic clamping time (MD=16.05,95％CI 2.47-29.62,P=0.02) was significantly longer than that in the Median Sternotomy group.Conclusion Compared with the Median Sternotomy group totally thorascopic group significantly reduces postoperative ventilation time,hospital stay time and postoperative drainage,but there is the risk of prolonged aortic cross-clamping time.Due to the quantity and quality of the included studies,the above conclusions still needs to be verified by carrying out more studies.