BACKGROUND Obese patients(body mass index≥30 kg/m^(2))undergoing isolated aortic valve replacement(AVR)face increased surgical risks due to comorbidities.Partial upper sternotomy(PUS),a minimally invasive approach,ma...BACKGROUND Obese patients(body mass index≥30 kg/m^(2))undergoing isolated aortic valve replacement(AVR)face increased surgical risks due to comorbidities.Partial upper sternotomy(PUS),a minimally invasive approach,may reduce complications compared to full median sternotomy(FMS).We hypothesize that PUS improves outcomes over FMS in obese patients undergoing AVR.AIM To compare the efficacy and safety of PUS vs FMS in obese patients undergoing isolated AVR.METHODS This systematic review and meta-analysis followed PRISMA guidelines,searching PubMed,EMBASE,and Cochrane databases for observational studies comparing PUS vs FMS in obese patients undergoing AVR.Outcomes were analyzed using odds ratios(OR),mean differences(MD),95%confidence intervals(CI),I^(2)statistic,and Newcastle-Ottawa Scale was used for quality assessment.RESULTS Four observational studies involving 677 patients were analyzed.PUS reduced intensive care unit stay(MD-2.67 days,95%CI:-4.43 to-0.90,P=0.003,I^(2)=78%)but increased cardiopulmonary bypass time(MD 5.62 minutes,95%CI:-0.36 to 11.59,I^(2)=55%).No differences were observed in renal failure(OR 1.13,95%CI:0.63-2.94,I^(2)=0%),atrial fibrillation(OR 0.81,95%CI:0.43-1.54,I^(2)=30%),reexploration(OR 1.09,95%CI:0.48-2.47,I^(2)=0%),postoperative bleeding(OR 1.48,95%CI:0.53-4.15,I^(2)=60%),wound infection(OR 1.23,95%CI:0.70-2.14,I^(2)=0%),hospital stay(MD 0.51 days,95%CI:-4.13 to 5.15,I^(2)=90%),or cross-clamp time(MD 4.03 minutes,95%CI:-0.75 to 8.80,I^(2)=50%).CONCLUSION PUS is safe and effective for obese patients undergoing AVR,reducing intensive care unit stay and enhancing recovery,provided surgical expertise is available.展开更多
Objective:Comparative studies of median sternotomy and partial upper sternotomy in total arch replacement for type A aortic dissection are rare,and the safety and benefits of partial upper sternotomy need further eval...Objective:Comparative studies of median sternotomy and partial upper sternotomy in total arch replacement for type A aortic dissection are rare,and the safety and benefits of partial upper sternotomy need further evaluation.This study aimed to explore the effectiveness and prognosis of partial upper sternotomy in total arch replacement among patients with type A aortic dissection.Methods:This is a retrospective study of patients who underwent total arch replacement for type A aortic dissection at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2016 and December 2019.They were grouped into the median sternotomy and partial upper sternotomy groups according to the different treatment methodologies.The intra-operative and prognostic indicators were compared between both groups.Results:Forty-nine patients were included:31 in the median sternotomy group and 18 in the partial upper sternotomy group.The partial upper sternotomy group had a shorter incision((9.0±0.8)cm vs.(25.5±1.3)cm,P=0.02)and smaller postoperative total drainage volume(885mL vs.1,820mL,P=0.03)than the median sternotomy group.The differences between the 2 groups with respect to other intra-operative indicators such as operation duration,cardiopulmonary bypass duration,aortic occlusion duration,hypothermic circulatory arrest duration,and intra-operative blood loss,and prognostic indicators such as red blood cell infusion,ventilator aid duration,cardiac intensive care unit stay,postoperative hospital stay,and postoperative complications were not significantly different(all P>0.05).Conclusions:The utilization of partial upper sternotomy in patients with type A aortic dissection resulted in a smaller incision and more aesthetically pleasing scar,along with reduced drainage volume compared to median sternotomy.展开更多
文摘BACKGROUND Obese patients(body mass index≥30 kg/m^(2))undergoing isolated aortic valve replacement(AVR)face increased surgical risks due to comorbidities.Partial upper sternotomy(PUS),a minimally invasive approach,may reduce complications compared to full median sternotomy(FMS).We hypothesize that PUS improves outcomes over FMS in obese patients undergoing AVR.AIM To compare the efficacy and safety of PUS vs FMS in obese patients undergoing isolated AVR.METHODS This systematic review and meta-analysis followed PRISMA guidelines,searching PubMed,EMBASE,and Cochrane databases for observational studies comparing PUS vs FMS in obese patients undergoing AVR.Outcomes were analyzed using odds ratios(OR),mean differences(MD),95%confidence intervals(CI),I^(2)statistic,and Newcastle-Ottawa Scale was used for quality assessment.RESULTS Four observational studies involving 677 patients were analyzed.PUS reduced intensive care unit stay(MD-2.67 days,95%CI:-4.43 to-0.90,P=0.003,I^(2)=78%)but increased cardiopulmonary bypass time(MD 5.62 minutes,95%CI:-0.36 to 11.59,I^(2)=55%).No differences were observed in renal failure(OR 1.13,95%CI:0.63-2.94,I^(2)=0%),atrial fibrillation(OR 0.81,95%CI:0.43-1.54,I^(2)=30%),reexploration(OR 1.09,95%CI:0.48-2.47,I^(2)=0%),postoperative bleeding(OR 1.48,95%CI:0.53-4.15,I^(2)=60%),wound infection(OR 1.23,95%CI:0.70-2.14,I^(2)=0%),hospital stay(MD 0.51 days,95%CI:-4.13 to 5.15,I^(2)=90%),or cross-clamp time(MD 4.03 minutes,95%CI:-0.75 to 8.80,I^(2)=50%).CONCLUSION PUS is safe and effective for obese patients undergoing AVR,reducing intensive care unit stay and enhancing recovery,provided surgical expertise is available.
文摘Objective:Comparative studies of median sternotomy and partial upper sternotomy in total arch replacement for type A aortic dissection are rare,and the safety and benefits of partial upper sternotomy need further evaluation.This study aimed to explore the effectiveness and prognosis of partial upper sternotomy in total arch replacement among patients with type A aortic dissection.Methods:This is a retrospective study of patients who underwent total arch replacement for type A aortic dissection at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2016 and December 2019.They were grouped into the median sternotomy and partial upper sternotomy groups according to the different treatment methodologies.The intra-operative and prognostic indicators were compared between both groups.Results:Forty-nine patients were included:31 in the median sternotomy group and 18 in the partial upper sternotomy group.The partial upper sternotomy group had a shorter incision((9.0±0.8)cm vs.(25.5±1.3)cm,P=0.02)and smaller postoperative total drainage volume(885mL vs.1,820mL,P=0.03)than the median sternotomy group.The differences between the 2 groups with respect to other intra-operative indicators such as operation duration,cardiopulmonary bypass duration,aortic occlusion duration,hypothermic circulatory arrest duration,and intra-operative blood loss,and prognostic indicators such as red blood cell infusion,ventilator aid duration,cardiac intensive care unit stay,postoperative hospital stay,and postoperative complications were not significantly different(all P>0.05).Conclusions:The utilization of partial upper sternotomy in patients with type A aortic dissection resulted in a smaller incision and more aesthetically pleasing scar,along with reduced drainage volume compared to median sternotomy.
