二尖瓣置换手术保留瓣下结构对患者术后早期心脏结构功能及安全性影响的Meta分析

A meta-analysis of the effect of subvalvular structure preservation in mitral valve replacement on the short-term cardiac structure function and safety

目的 系统性评价二尖瓣置换手术保留瓣下结构手术方式与未保留瓣下结构手术方式对患者术后心脏结构功能及安全性的影响。方法 计算机检索数据库包括Pubmed、Web of Science、COCHRANE LIBRARY、WanFangData、CBM和CNKI Data,检索时限从建库至2021年10月,同时追索纳入文章的参考文献。严格按照纳入标准筛选文献,并提取资料、评估质量,应用Review Manager 5.2软件对所纳入的研究结果进行Meta分析。结果 共纳入随机对照研究2个、前瞻非随机对照研究1个及回顾性研究16个,包括3 278例患者,其中保留瓣下结构手术方式患者1 774例,未保留瓣下结构手术方式患者1 504例。Meta分析结果显示:两组左心室舒张末期内径(MD=-4.13,P <0.01)、左心室收缩末期内径(MD=-5.08,P <0.01)、左心室短轴缩短率(MD=3.18,P <0.01)、左心室射血分数(MD=5.37,P <0.01)、围手术期死亡率(OR=0.46,P <0.01)、低心排血量综合征(OR=0.42,P <0.01),差异有统计学意义。结论 保留瓣下结构手术方式组与未保留瓣下结构手术方式组相比,患者在术后心脏结构功能及术后安全性方面有获益。

Objective To systematically evaluate the effect of subvalvular structure preservation versus non-subvalvular structure preservation on cardiac structure and function and safety in patients undergoing mitral valve replacement. Methods The databases including Pubmed, Web of Science,COCHRANE LIBRARY, WanFang Data, CBM and CNKI Data were searched from inception to October 2021. The reference lists were also searched. Literature selection were strictly in accordance with the inclusion criteria. The data was extracted and the quality was assessed. Review Manager 5.2 software was used to conduct meta-analysis of the included results. Results 2 randomized controlled trials(RCT),1 prospective non-randomized controlled study and 16 retrospective studys involving 3 278 patients were included. Among them, there were 1 774 patients with subvalvular structure preservation and 1 504 patients without subvalvular structure preservation. The meta-analysis showed that the differences of left ventricular end-diastolic diameter(MD=-4.13, P < 0.01), left ventricular end-systolic diameter(MD=-5.08,P < 0.01), left ventricular short axis shortening rate(MD=3.18, P < 0.01), left ventricular ejection fraction(MD=5.37, P < 0.01), perioperative mortality(OR=0.46, P < 0.01), low cardiac output syndrome(OR=0.42, P < 0.01) between the two groups had statistical significance. Conclusion Patients in the subvalvular structure preserving surgery group have benefits in postoperative cardiac structure function and postoperative safety compared with those in the non-subvalvular structure preserving surgery group.