Key result
In a network meta-analysis of 5 surgical methods for mitral regurgitation, 3D endoscopic mitral valve surgery had the lowest rate of complications (OR 0.65; 95% CI 0.13-3.00).
Why the study?
The comparative effectiveness of different surgical methods for mitral regurgitation in adults was evaluated to provide reference for selecting the best surgical scheme.
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)
Network meta-analysis suggests 3D endoscopic mitral valve surgery may offer the most satisfactory safety profile among minimally invasive options for mitral regurgitation, though wide confidence intervals indicate uncertainty.
Favors 3D endoscopic mitral valve surgery for fewer complications; leaves optimal approach unresolved given imprecise estimates.
Objective This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using 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). Addis1.16.8 software was used for network meta-analysis. Results A total of 31 studies were included, 12998 patients, involving 5 surgical methods. Network Meta analysis showed that: in terms of complications (OR: 0.65, 95% CI: 0.13 to 3.00, probability rank = 0.37) and mitral regurgitation (OR:0.03, 95%CI: 0.0 to 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 to 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 These 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 (R-MVS, T-MVS, M-MVS, C-MVS) was evaluated on complications (OR 0.65, 95% CI 0.13 to 3.00). In a network meta-analysis of 5 surgical methods for mitral regurgitation, 3D endoscopic mitral valve surgery had the lowest rate of complications (OR 0.65; 95% CI 0.13-3.00).
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