Total Thoracoscopy Versus Median Sternotomy For Cardiac Surgery In China: A Systematic Review

Objective：To evaluate whether totally thoracoscopic surgery has advantagesover conventional median sternotomy,so as to provide evidence for clinical diagnosisand therapy.Methods：We searched CNKI, CBM, Wanfang Data, VIP from2000through2012.The literature about the therapeutic effect of totally thoracoscopic surgery andconventional median sternotomy was identified.The Meta-analyses were performedusing RevMan4.2software.Results：A total of8stydies involving409TTS patients and419MS patientsmet the inclusion criteria.The result of meta-analyses showed that the TTS group isbetter than MS group in mechanical ventilation time[WMD＝-0.77，95﹪CI﹙-1.48,-0.06﹚P＝0.03], chest-tube drainage [WMD＝-54.35，95﹪CI﹙-73.97,-34.73﹚P﹤0.00001]and postoperation hospitalization duration[WMD＝-2.48，95﹪CI﹙-3.32,-1.55﹚P﹤0.00001].But the cardiopulmonary bypass time[WMD＝4.53，95﹪CI﹙-2.02,11.08﹚P＝0.18], aortic crossclamp time[WMD＝0.69，95﹪CI﹙-2.83,4.61﹚P＝0.64], operation time[WMD＝0.19，95﹪CI﹙-0.09,0.48﹚P＝0.19], operative complication rate[OR＝1.46，95﹪CI﹙0.76,2.82﹚P＝0.26]werenot significantly different between the two groups.Conclusion：Totally thoracoscopic surgery is better than conventional mediansternotomy in mechanical ventilation time,chest-tube drainage and postoperationhospitalization duration,and has unique advantages in surgical injury andpostoperative recovery.