Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis.
Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis.
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DOI：
10.1016/j.athoracsur.2010.06.034
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发表时间：
2010-11
影响因子：
4.6
通讯作者：
Argenziano, Michael
中科院分区：
文献类型：
--
作者：
Iribarne, Alexander;Russo, Mark J.;Easterwood, Rachel;Hong, Kimberly N.;Yang, Jonathan;Cheema, Faisal H.;Smith, Craig R.;Argenziano, Michael
在过去的十年里，微创(MI)二尖瓣手术越来越流行。本研究的目的是使用倾向性分析方法比较经MI和传统胸骨切开(ST)的二尖瓣修复术和置换术的短期和长期结果，以考虑基线风险的差异。从2000年1月至2008年12月，我所共施行了1121例二尖瓣离断手术(ST段548例，MI段573例)。回顾性收集了所有患者的数据，并建立了Logistic回归模型来预测MI与ST入路的选择。然后，基于回归模型生成倾向分数，并使用1：1最近邻匹配创建匹配对。在分析中有382对配对，总样本量为764，占原始队列的68.2%。主要结果包括：体外循环时间(CPB)、交叉阻断时间(XCT)、住院时间(LOS)、主要住院并发症以及短期和长期存活期。心肌梗死组体外循环时间为117.1±2.0min，心肌梗死组为139.7±2.6min(P<0.0001)；ST段患者平均LOS为9.81±0.61d，MI组为7.76±0.37d(P=0.0043)。两组之间主要住院并发症的发生率没有显著差异。术后平均生存时间4.2±2.4年。30天(p=0.622)和1年(p=0.599)的死亡率无显著差异。此外，两组间的长期存活率无显著差异(p=0.569)。虽然微创二尖瓣手术需要稍长的体外循环，但在XCT、发病率和死亡率方面没有差别，与匹配的胸骨切开对照组相比，LOS显著缩短。
Over the past decade, minimally invasive (MI) mitral valve surgery has grown in popularity. The purpose of this study was to compare both short and long-term outcomes of mitral valve repair and replacement performed through a MI versus traditional sternotomy (ST) incision using a propensity analysis approach to account for differences in baseline risk. From January 2000 – December 2008, a total of 1121 isolated mitral valve operations were performed at our institution (548 ST, 573 MI). Data were retrospectively collected on all patients and a logistic regression model created to predict selection to a MI versus ST approach. Propensity scores were then generated based on the regression model and matched pairs created using 1:1 nearest neighbor matching. There were 382 matched pairs in the analysis for a total sample size of 764, or 68.2% of the original cohort. Major outcomes of interest included: cardiopulmonary bypass time (CPB), cross clamp time (XCT), hospital length of stay (LOS), major in-hospital complications, and both short- and long-term survival. CPB was 117.1 ± 2.0 minutes in the ST and 139.7 ± 2.6 minutes in the MI group (p<0.0001), and XCT was 79.6 ± 1.5 minutes in the ST and 83.7 ± 1.9 in the MI group (p=0.106). The average LOS was 9.81 ± 0.61 days among ST and 7.76 ± 0.37 days among MI patients (p=0.0043). There was no significant difference in the frequency of major in-hospital complications between groups. The mean duration of survival follow-up was 4.2 ± 2.4 years. There was no significant difference in mortality at 30 days (p=0.622) or 1 year (p=0.599). In addition, there was no significant difference in long-term survival between groups (p=0.569). Although minimally invasive mitral valve surgery required a slightly longer CPB, there was no difference in XCT, morbidity, or mortality, and LOS was significantly shorter when compared to matched sternotomy controls.
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DOI：
10.1016/s0022-5223(98)00448-6
发表时间：
1998-11-01
影响因子：
6
作者：
Aklog, L;Adams, DH;Cohn, LH
通讯作者：
Cohn, LH
影响因子：
4.6
作者：
Aybek, T;Dogan, S;Moritz, A
通讯作者：
Moritz, A
影响因子：
4.8
作者：
Apolito, Renato A.;Greenberg, Mark A.;Hochman, Judith S.
通讯作者：
Hochman, Judith S.
影响因子：
12.7
作者：
WENTWORTH, DN;NEATON, JD;RASMUSSEN, WL
通讯作者：
RASMUSSEN, WL
影响因子：
4.6
作者：
Karagoz, HY;Bayazit, K;Sönmez, B
通讯作者：
Sönmez, B