Minimally invasive (mini-thoracotomy) versus median sternotomy in redo mitral valve surgery: A meta-analysis of observational studies

Abstract

Objective Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery. Method The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I2-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients. Results There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups. Conclusion Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.

Redo mitral surgery after coronary artery bypass grafts under hyperkalemic hypothermia using thoracotomy and axillary artery cannulation in a patient with functioning bilateral internal thoracic arteries and atheromatous aorta

“…The right minithoracotomy approach provides an excellent operative view of the mitral valve without requiring the dissection of the adhesion and ITA grafts after CABG with median sternotomy. Evidence also shows that redo mitral surgery via the right thoracotomy reduces mortality as well as shorter hospital stay compared with remedian sternotomy [ 6 ].…”

Mitral Valve Re-Repair Due to Chordal Pseudo-Elongation Through Repeated Right Anterior Minithoracotomy

“…2,15,16 A recent meta-analysis including 7 retrospective observational studies and 1,070 patients published by Hussain and colleagues comparing minimally invasive (minithoracotomy) with median sternotomy in redo mitral valve surgery found reduced in-hospital mortality and hospital length of stay in the minimally invasive group, with otherwise comparable results. 17 Unfortunately, no information was available on whether an MVr or MV replacement was performed.…”

Anaesthesia for Minimally Invasive Cardiac Surgery

“…Two recent meta-analyses comparing MIMVS vs. conventional resternotomy for redo mitral valve surgery showed an improved mortality rate in patients who had a minimally invasive approach rather than resternotomy [30,31]. A recent analysis of patients having mitral surgery after a previous sternotomy in the national Netherlands heart registry showed no difference in thirty-day mortality or five-year survival, although there was a lower incidence of prolonged intubation and new-onset arrhythmia in the minimally invasive group [32].…”