Minimally Invasive Versus Sternotomy Approach for Mitral Valve Surgery in Patients Greater Than 70 Years Old: A Propensity-Matched Comparison

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

“…Our search revealed seven studies [8][9][10][11][12][13][14] fulfilling these inclusion criteria, producing a pooled data set of 1,254 patients of whom 731 underwent ST and 523 underwent MIMVS (Table 2). There was 100% concordance between reviewers, equating to a Cohen's kappa coefficient of 1.…”

“…Five studies were retrospective observational in design [8,10,[12][13][14], and two were propensity-matched studies ST ¼ sternotomy. [9,11]. Two studies, although observational, included two very homogeneous populations [8,10].…”

“…Mihos and colleagues [8] included infective endocarditis and chronic obstructive pulmonary disease (40.9%) and redo operations (18.1%); Tang and associates [9] included patients with chronic renal failure and New York Heart Association functional class IV (43%), redo operations (37.7%), infective endocarditis (17.7%), and chronic obstructive pulmonary disease (22.2%); Iribarne and coworkers [10] included patients older than 75 years and those with chronic obstructive pulmonary disease (18.5%); Holzhey and colleagues [11] included patients older than 70 years and those with redo operations (14.7%), chronic obstructive pulmonary disease (8.6%), infective endocarditis (4.9%), and left ventricular ejection fraction of less than 30% (4.9%); and Sharony and associates [12], Bolotin and coworkers [13], and Burfeind and colleagues [14] included specifically redo patients (Table 2). Combined procedures (tricuspid valve) were also included in the studies by Tang and coworkers [9], Holzhey and colleagues [11], and Sharony and associates [12]. Moreover, the modified NewcastleOttawa scale based on 17 EuroSCORE II risk factors was used to both check comparability and numbers of risk factors included.…”

“…The overall quality of studies is outlined in Table 4. Of the seven studies included in this review, four were considered to be of high quality, scoring above the median of 7 points (Table 4) [8][9][10][11]. Analysis of high-quality studies did not demonstrate a significant difference in terms of the primary outcome early mortality (OR, 0,98; 95% CI, 0.45 to 2.10; p ¼ 0.93), but most importantly, no heterogeneity was detected for this primary outcome (c 2 , 4.25; I 2 , 29%; p ¼ 0.29; Table 5; Fig 2B.).…”

“…No study fulfilled all three of these criteria (Fig 3A). Two studies were propensity matched [9,11], and two others were corrected for potential confounders [8,10]. Funnel plots were used to assess for publication bias for all primary and secondary outcomes.…”