Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Moscarelli, Marco; Fattouch, Khalil; Gaudino, Mario; Nasso, Giuseppe; Paparella, Domenico; Punjabi, Prakash P; Athanasiou, Thanos; Benedetto, Umberto; Angelini, Gianni; Santarpino, Giuseppe; Saglio, Giuseppe

doi:10.1016/j.athoracsur.2019.07.034

Cited by 37 publications

(48 citation statements)

References 26 publications

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“…According to the Phan et al Bayesian network meta-analysis, the right mini-thoracotomy approach for aortic valve replacement (AVR) was associated to a significantly increased CPB and cross-clamp time compared to sternotomy approach (P=0.001) (17). The same applies to minimally invasive mitral procedures; in a recently published meta-analysis by Moscarelli et al including 1,905 patients, minimally invasive mitral valve surgery was associated with a mean 32 mins of additional CPB duration (P<0.01) compared to sternotomy approach (18). Even in totally endoscopic CABG (TECAB) the current trend favors implementation of CPB (19,20) rather than operating off-pump.…”

Section: Rationalementioning

confidence: 99%

From less invasive to minimal invasive extracorporeal circulation

Anastasiadis¹,

Antonitsis²,

Deliopoulos³

et al. 2021

J Thorac Dis

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Development of minimally invasive cardiac surgery (MICS) served the purpose of performing surgery while avoiding the surgical stress triggered by a full median sternotomy. Minimizing surgical trauma is associated with improved cosmesis and enhanced recovery leading to reduced morbidity. However, it has to be primarily appreciated that the extracorporeal circulation (ECC) stands for the basis of nearly all MICS procedures. With some fundamental modification and advancement in perfusion techniques, the use of ECC has become the enabling technology for the development of MICS. Less invasive cardiopulmonary bypass (CPB) techniques are based on remote cannulation and optimization of perfusion techniques with assisted venous drainage and use of centrifugal pump, so as to facilitate the demanding surgical maneuvers, rather than minimizing the invasiveness of the CPB. This is reflected in the increased duration of CPB required for MICS procedures. Minimal invasive Extracorporeal Circulation (MiECC) represents a major breakthrough in perfusion. It integrates all contemporary technological advancements that facilitate best applying cardiovascular physiology to intraoperative perfusion. Consequently, MiECC use translates to improved end-organ protection and clinical outcome, as evidenced in multiple clinical trials and meta-analyses. MICS performed with MiECC provides the basis for developing a multidisciplinary intraoperative strategy towards a "more physiologic" cardiac surgery by combining small surgical trauma with minimum body's physiology derangement. Integration of MiECC can advance MICS from non-full sternotomy for selected patients to a "more physiologic" surgery, which represents the real face of modern cardiac surgery in the transcatheter era.

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Section: Rationalementioning

confidence: 99%

From less invasive to minimal invasive extracorporeal circulation

Anastasiadis¹,

Antonitsis²,

Deliopoulos³

et al. 2021

J Thorac Dis

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show abstract

“…These skills are associated with a distinct learning curve-some have suggested an estimated 75-125 procedures to attain proficiency (11,12). Patients requiring more complex repairs can be considered suitable in more experienced hands (12,13). However, by taking a standardized approach, these skills can easily be acquired and developed.…”

Section: Patient Selectionmentioning

confidence: 99%

“…This highlights the importance of preoperative vascular assessment. As such, a recently published meta-analysis reports low incidence of neurological events in peripherally cannulated patients undergoing MIMVS (13). Less commonly, some surgeons opt for central cannulation.…”

Section: Establishment Of Cpbmentioning

confidence: 99%

“…In terms of outcomes, a recently published meta-analysis by Moscarelli et al included 18 studies with a cumulative 1,905 patients examining several outcome measures that include: recurrence of moderate-severe MR, need for reoperation after either MIMVS or sternotomy. The study reported no significant differences between minimally invasive and sternotomy approaches in terms of recurrent MR or redo operation rates (1.7% vs. 1.3%, respectively, P=0.22), failed repair rates (1.6% vs. 3%, respectively, P=0.66) or in hospital mortality (1% vs. 1.3%, respectively, P=0.6) (13). Some of the important outcomes are summarised in Table 4.…”

Section: Introducing Mimvs As a New Techniquementioning

confidence: 95%

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Minimally invasive mitral valve surgery

et al. 2021

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There is considerable interest and demand in the application of minimally invasive techniques in cardiac surgery driven by multiple factors including patient cosmesis and satisfaction, reduction of surgical trauma and the development of specialized instrumentation that allows these procedures to be performed safely. Minimally invasive mitral valve surgery (MIMVS) has been conducted for more than 25 years and has been shown to offer multiple benefits including better cosmetic results, enhanced post-operative recovery, improved patient satisfaction and most importantly, equivalent clinical outcomes with regards to quality and safety when compared to the standard sternotomy approach. MIMVS may be particularly beneficial in certain subgroups of patients, for example patients undergoing redo mitral valve surgery. In this article, we discuss patient selection criteria for MIMVS, the merits and drawbacks of MIMVS relative to conventional sternotomy approaches, and detail procedural aspects including anaesthetic management, intraoperative technique, and important considerations in myocardial protection and cardiopulmonary bypass (CPB).When considering developing a MIMVS programme, as for any new technique, a team approach to the introduction of the programme is essential. Although it is clear that patient selection is important, particularly early in a surgical programme, with experience complex repairs can be performed through a minimally invasive approach with excellent outcomes.

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“…Moscarelli and colleagues compared traditional median sternotomy to a minimally invasive approach for repair of complex mitral valve disease (MVD), specifically bileaflet and Barlow's mitral valve disease. 9 They specifically examined how each approach affected the long-term outcomes of these patients by seeing if either technique was more or less likely to result in moderate mitral regurgitation (MR) or mitral valve re-operation over a period of up to 10 years. This information had previously been looked at in several single center studies at high volume centers and found no difference between the two approaches.…”

Section: Updates In Valvular Diseasementioning

confidence: 99%

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

Martin

Weiner

Feinman

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis

Cited by 37 publications

References 26 publications

From less invasive to minimal invasive extracorporeal circulation

From less invasive to minimal invasive extracorporeal circulation

Minimally invasive mitral valve surgery

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

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