■微创心脏手术(MICS)正在全球范围内增加。在大多数情况下,手术技术包括腹股沟插管以建立体外循环,需要第二个手术切口(SC)来暴露和插管股血管。随着动脉闭合装置的引入,腹股沟的经皮插管(PC)已成为一种可能的替代方法。我们进行了荟萃分析和系统评价,以比较接受PC和SC的MICS患者的临床终点。
■评估了三个数据库。主要结果是任何进入部位并发症。次要结局是围手术期死亡率,任何伤口并发症,任何血管并发症,淋巴并发症,股/髂动脉狭窄,中风,程序持续时间,住院时间(LOS)。进行了随机效应模型。
■共纳入5项研究,共2,038名患者。与PC相比,接受SC的患者显示出较高的任何进入部位并发症发生率(比值比[OR]=3.09,95%置信区间[CI]:1.87至5.10,P<0.01),任何伤口并发症(OR=10.10,95%CI:3.31至30.85,P<0.01),淋巴并发症(OR=9.37,95%CI:2.15~40.81,P<0.01),和更长的手术持续时间(标准化平均差=0.31,95%CI:0.12至0.51,P<0.01)。两组围手术期死亡率无显著差异,任何血管并发症,股/髂动脉狭窄,中风,或医院LOS。
■分析表明,与PC相比,MICS中的手术腹股沟插管与任何进入部位并发症(尤其是伤口并发症和淋巴瘘)的发生率更高,并且手术时间更长。围手术期死亡率无差异。
UNASSIGNED: Minimally invasive cardiac surgery (MICS) is increasing worldwide. In most cases, the surgical technique includes cannulation of the groin for the establishment of cardiopulmonary bypass, requiring a second surgical incision (SC) for exposure and cannulation of the femoral vessels. With the introduction of arterial closure devices, percutaneous cannulation (PC) of the groin has become a possible alternative. We performed a meta-analysis and systematic
review to compare clinical endpoints between the patients who underwent PC and SC for MICS.
UNASSIGNED: Three databases were assessed. The primary outcome was any access site complication. Secondary outcomes were perioperative mortality, any wound complication, any vascular complication, lymphatic complications, femoral/iliac stenosis, stroke, procedural duration, and hospital length of stay (LOS). A random effects model was performed.
UNASSIGNED: A total of 5 studies with 2,038 patients were included. When compared with PC, patients who underwent SC showed a higher incidence of any access site complication (odds ratio [OR] = 3.09, 95% confidence interval [CI]: 1.87 to 5.10, P < 0.01), any wound complication (OR = 10.10, 95% CI: 3.31 to 30.85, P < 0.01), lymphatic complication (OR = 9.37, 95% CI: 2.15 to 40.81, P < 0.01), and longer procedural duration (standardized mean difference = 0.31, 95% CI: 0.12 to 0.51, P < 0.01). There was no significant difference between the 2 groups regarding perioperative mortality, any vascular complication, femoral/iliac stenosis, stroke, or hospital LOS.
UNASSIGNED: The analysis suggests that surgical groin cannulation in MICS is associated with a higher incidence of any access site complication (especially wound complication and lymphatic fistula) and with a longer procedural time compared with PC. There was no difference in perioperative mortality.