Total thoracoscopic surgery vs.median sternotomy in treating congenital heart diseases: a meta-analysis

AIM: To evaluate the efficacy and safety of using total thoracoscopic surgery(TTS) and median sternotomy(MS) in treating congenital heart diseases(CHD).METHODS: Databases of PubMed,Embase,Cochrane Library(Issue 7,2012),VIP,CNKI,CBM and Wanfang were searched from the date of database establishment to June 2012 for randomized controlled trials(RCTs) and controlled clinical trials(CCTs) concerning the treatment of CHD.References of those studies were also searched by hand.The language was limited to Chinese and English.After selection,data extraction and quality assessments were independently conducted by two reviewers and meta-analyses were performed using RevMan 5.1 software.RESULTS: A total of nine studies involving 364 TTS patients and 384 MS patients met the inclusion criteria.Of these nine studies,three were RCTs and the other six were CCTs.Resultsof meta-analyses showed that the TTS group had a better postoperative effect.Time of mechanical respiration(WMD=-1.17,95% CI: 2.15 to-0.20,P<0.05),time in ICU(WMD=-12.22,95% CI-17.34 to-7.10,P<0.01),chest-tube drainage(WMD=-2.36,95% CI:-3.42 to-1.18,P<0.01) and hospitalization days(WMD=-1.92,95% CI:-2.69 to-1.16,P<0.01) in TTS group were less than those in MS group.Aorta cross-clamping time(WMD=5.70,95% CI: 1.33 to 10.07,P=0.01) and bypass time(WMD=13.08,95% CI: 3.48 to 22.69,P<0.01) in TTS group were longer than those in MS group.Surgical time(WMD=0.25,95% CI:-0.18 to 0.69,P=0.25) and incidence of postoperative complications(OR=1.21,95% CI: 0.50 to 2.92,P>0.05) were not significantly different between groups.CONCLUSION: TTS in treating CHD is feasible and safe with less trauma,faster recovery and good cosmetic results.