Key result
3D endoscopic mitral valve surgery had the lowest event rate for complications (OR 0.65; 95% CI 0.13-3.00) and recurrent mitral regurgitation compared to other surgical methods.
Why the study?
Comparative effectiveness data among different surgical approaches for adult mitral regurgitation were needed to help guide the selection of the optimal surgical approach.
Do different minimally invasive surgical methods improve outcomes compared to traditional thoracotomy in adults with mitral regurgitation?
Meta-Analysis (n=12,998)
Do different minimally invasive surgical methods improve outcomes compared to traditional thoracotomy in adults with mitral regurgitation?
Odds Ratio: 0.65 (95% CI 0.13–3)
Among surgical methods for mitral regurgitation, 3D endoscopic mitral valve surgery appears to offer the most satisfactory overall outcomes regarding complications and residual MR, though confidence intervals are wide and further studies are needed.
3D endoscopic mitral valve surgery may minimize complications and recurrent MR; leaves open superiority confirmation in randomized trials.
OBJECTIVE: This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme. METHODS: The PubMed, EMBASE, the Cochrane Library, CNKI, and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery (3D-MVS), robot-assisted mitral valve surgery (R-MVS); totally thoracoscopic mitral valve surgery (T-MVS), small incision mitral valve surgery (M-MVS), and traditional thoracotomy mitral valve surgery (C-MVS). Stata16.0 and Addis1.16.8 software was used for network meta-analysis using the Bayesian approach. RESULTS: A total of 31 studies were included, 12,998 patients, involving five surgical methods. Network meta-analysis showed that: in terms of complications (odds ratio [OR]: 0.65, 95% CI: 0.13-3.00, probability rank = 0.37) and MR (OR: 0.03, 95% CI: 0.0-8315, probability rank = 0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16-1.84, probability rank = 0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect. CONCLUSION: This minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.
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Huang et al. (2021) conducted a meta-analysis in mitral regurgitation (n=12,998). 3D endoscopic mitral valve surgery (3D-MVS) vs. Other surgical methods including traditional thoracotomy (C-MVS) was evaluated on Complications (OR 0.65, 95% CI 0.13-3.00). 3D endoscopic mitral valve surgery had the lowest event rate for complications (OR 0.65; 95% CI 0.13-3.00) and recurrent mitral regurgitation compared to other surgical methods.
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