Objectives

To compare outcomes of mitral valve surgery through conventional left atriotomy (LA) and transeptal approach (TS).

Method

PRISMA guidelines were followed. Primary outcomes were operative mortality and permanent pacemaker (PPM) implantation; secondary outcomes were new onset of atrial fibrillation (AF), stroke and operative times.

Results

Sixteen articles met the inclusion criteria with 4,537 patients. Cardiopulmonary bypass was longer with TS (WMD -16.44 minutes [-29.53, -3.36], p=0.01). Rates of PPM implantation (RR 0.65 [0.47, 0.89], p=0.007) and new onset AF (RR 0.87 [0.78, 0.97], p=0.02) were higher with TS. Subgroup analysis isolated mitral valve surgery cohort showed no difference in operative times, mortality, new AF, stroke, and PPM implantation.

Conclusions

Equal outcomes between both approaches during isolated mitral valve surgery; however, TS was associated with longer operative times and higher postoperative AF and PPM rates when pooling combined procedures. A large randomized controlled trial is required to confirm those findings.

中文翻译：

---

二尖瓣手术的左房或经耳途径：系统评价和荟萃分析。

目标

比较通过常规左房切开术（LA）和经阴道入路（TS）进行二尖瓣手术的结果。

方法

遵循PRISMA指南。主要结果是手术死亡率和永久性起搏器植入。次要结果是房颤，卒中和手术时间的新发作。

结果

符合纳入标准的16篇文章涉及4,537例患者。TS患者的心肺旁路术时间更长（WMD -16.44分钟[-29.53，-3.36]，p = 0.01）。TS组的PPM植入率（RR 0.65 [0.47，0.89]，p = 0.007）和新发房颤（RR 0.87 [0.78，0.97]，p = 0.02）较高。对孤立的二尖瓣手术队列进行亚组分析，结果显示手术时间，死亡率，新发房颤，中风和PPM植入无差异。

结论

在孤立的二尖瓣手术中两种方法的结果相同；但是，合并联合手术时，TS与手术时间更长，术后AF和PPM率更高相关。需要进行大规模的随机对照试验来证实这些发现。