Mini-thoracotomy vs. conventional sternotomy mitral valve surgery: a systematic review and meta-analysis

Otaibi, Abdullah Al; Gupta, Saurabh; Belley‐Côté, Emilie P.; Alsagheir, Ali; Spence, Jessica; Parry, Dominic; Whitlock, Richard

doi:10.23736/s0021-9509.16.09603-8

Cited by 25 publications

(18 citation statements)

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“…Yet, multivariate analyses with EuroSCORE2 adjustment were applied to reduce this bias, and similar results were obtained. These results are in accordance with the publication of Al Otaibi et al [ 21 ].…”

Section: Discussionsupporting

confidence: 94%

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

Oezpeker

Barbieri

Höfer

et al. 2023

JCDD

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Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (n = 274), FS (n = 128) and PS (n = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; p = 0.018). Mortality was additionally reduced after the implementation of PS (p = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; p = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures.

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Section: Discussionsupporting

confidence: 94%

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

Oezpeker

Barbieri

Höfer

et al. 2023

JCDD

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“…Previous systematic reviews and meta‐analyses on the topic did not find differences in mortality. For instance, a meta‐analysis of RCTs by Alotaibi et al demonstrated no difference in mortality (RR: 0.5, 95% CI: [0.1−5.4]) 6 . Cheng et al 4 also found no difference in mortality in a pooled analysis of RCTs and observational data (RR: 1.0, 95% CI: [0.8−1.4]).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, a meta-analysis of RCTs by Alotaibi et al demonstrated no difference in mortality (RR: 0.5, 95% CI: [0.1−5.4]). 6 Cheng et al 4 p < .0001). 15 While our meta-analysis reaffirms the findings of previous studies, its breadth advances the understanding of the current literature on this topic.…”

Section: Summary Of Evidencementioning

confidence: 94%

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Minimally invasive mitral valve surgery versus conventional sternotomy mitral valve surgery: A systematic review and meta‐analysis of 119 studies

Eqbal

Gupta

Basha

et al. 2022

Journal of Cardiac Surgery

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Background and Aim of the Study Whether minimally invasive mitral valve surgery (MMVS) leads to better outcomes remains unclear. We conducted a systematic review and meta‐analysis comparing various MMVS approaches with conventional sternotomy. Methods We searched Cochrane CENTRAL, MEDLINE, EMBASE, ClinicalTrials. gov, and the ISRCTN Register for studies comparing minimally invasive approach (thoracotomy, port access, partial sternotomy, or robotic) with median sternotomy for mitral valve surgery. We performed title and abstract, full‐text screening, and data extraction independently and in duplicate. We pooled data using random effect models. Quality assessment was performed using validated tools. Certainty of evidence was established using the GRADE framework. Results One hundred and nineteen studies (n = 38,106) met eligibility criteria: eight randomized controlled trials (RCTs) and 111 observational studies. MMVS was associated with fewer days in hospital (RCT: MD: −2.2 days, 95% CI, [−3.7 to −0.8]; observational: MD: −2.4 days, 95% CI, [−2.7 to −2.1]). Observational studies suggested that MMVS reduced transfusion requirements with fewer units transfused per patient (MD: −1.2; 95% CI, [−1.6 to −0.9]) and fewer patients transfused (RR, 0.7; 95% CI, [0.6−0.7]). Observational data also suggested lower mortality with MMVS (RR, 0.6; 95% CI, [0.5−0.7], p < .001, I2 = 0%), but this was not corroborated by RCT data. The risk of postoperative mitral regurgitation (≥2+ or requiring re‐intervention) did not differ between the two groups. Conclusions MMVS may be associated with shorter length of hospital stay with no significant difference in short‐term morbidity and mortality. There is a paucity of high‐quality data on the long‐term outcomes of MMVS when compared with conventional sternotomy.

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“…It also offers the potential for shorter hospital stays and faster return to full activity, because less restriction is needed compared with sternotomy. 21 , 22 Although subjective, patients consistently voiced a high satisfaction, which was the case especially with patients who had previously undergone an open cardiac procedure.…”

Section: Discussionmentioning

confidence: 97%

Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract

Carr

Nijres

Windsor

et al. 2022

JAHA

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Background Until recently, a large right ventricle outflow tract interfered with the feasibility of standard transcatheter pulmonary valve replacement (PVR). We are describing our experience using a hybrid approach for PVR using a left anterior thoracotomy approach to allow for plication of the main pulmonary artery followed by a transcatheter PVR using a Sapien S3 valve. Methods and Results This is a single‐center, retrospective review of patients who were evaluated to be appropriate for a hybrid PVR approach. The patients' demographics, procedure details, and follow‐up data were collected. Between May 2018 and April 2021, a total of 11 patients presented for hybrid transcatheter PVR. The median age and weight were 24 years (interquartile range, 19–43 years) and 81.8 kg (interquartile range, 69–91 kg), respectively. Nine out of 11 patients received a transcatheter PVR after main pulmonary artery plication. There were no procedurally related deaths. One major complication was encountered in which the valve was malpositioned requiring successful surgical PVR. Minor complications included acute kidney injury (n=1) and a broken rib (n=1). The median length of stay was 4 days (interquartile range, 2–4 days), with median follow‐up of 7 months (interquartile range, 3–18 months). A well‐functioning pulmonary valve was observed in all patients at the last follow‐up. Conclusions A hybrid approach using left anterior thoracotomy with pulmonary artery plication followed by transcatheter Sapien S3 PVR provides a less‐invasive option for patients with an enlarged right ventricular outflow tract. Preliminary results demonstrated this to be a safe option with good short‐term outcomes.

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Mini-thoracotomy vs. conventional sternotomy mitral valve surgery: a systematic review and meta-analysis

Cited by 25 publications

References 0 publications

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

Minimally invasive mitral valve surgery versus conventional sternotomy mitral valve surgery: A systematic review and meta‐analysis of 119 studies

Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract

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