Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis

Brown, Morgan L.; McKellar, Stephen H.; Sundt, Thoralf M.; Schaff, Hartzell V.

doi:10.1016/j.jtcvs.2008.08.010

Cited by 321 publications

(311 citation statements)

References 34 publications

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“…Ding et al (2012) evaluated ALMT in congenital heart disease and suggested that this had a longer CPB time and ACCT, but shorter intubation time, ICU time, and LOHS. The remaining three studies compared a minimally invasive procedure with conventional sternotomy for aortic valve replacement (Murtuza et al, 2008;Brown et al, 2009;Khoshbin et al, 2011) and included RCTs and non-randomized studies. They concluded that a mini-sternotomy can be performed safely for aortic valve replacement without an increased risk of death, major complications (Khoshbin et al, 2011), a reduction in ICU stay time (Brown et al, 2009), or clinical benefit (Aybek et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…The remaining three studies compared a minimally invasive procedure with conventional sternotomy for aortic valve replacement (Murtuza et al, 2008;Brown et al, 2009;Khoshbin et al, 2011) and included RCTs and non-randomized studies. They concluded that a mini-sternotomy can be performed safely for aortic valve replacement without an increased risk of death, major complications (Khoshbin et al, 2011), a reduction in ICU stay time (Brown et al, 2009), or clinical benefit (Aybek et al, 2000). Moreover, we excluded 12 studies because they had no control groups (Loulmet et al, 1998;Mishra et al, 1999;Riess et al, 2001;Grossi et al, 2002;Onnasch et al, 2002b;Aybek et al, 2006;Martin et al, 2006;Seeburger et al, 2008;Glaubera et al, 2009;Müller et al, 2011;Reser et al, 2012), which ranged from 22 to 1339 in sample size.…”

Section: Discussionmentioning

confidence: 99%

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Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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“…The TAVI technology has been adopted in sutureless valves, which can be deployed under direct vision via conventional or minimally invasive approaches without the need of a catheter. Minimally invasive AVR (MAVR) has demonstrated similar results to conventional AVR in regards to clinical outcomes, with the added benefit of improved patient satisfaction (6).…”

Section: Introductionmentioning

confidence: 99%

Early results of the Sorin® Perceval S sutureless valve: systematic review and meta-analysis

Sian

Selvakumar

et al. 2017

J. Thorac. Dis.

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Background: Minimally invasive aortic valve replacement (MAVR) has demonstrated a benefit with respect to increased patient satisfaction due to minimised pain and earlier recovery. Sutureless valves may benefit MAVR and conventional aortic valve replacement (AVR) by reducing operative times and blood transfusion requirements. The Perceval valve (Sorin, Salluggia, Italy) is a self-expanding prosthesis made from bovine pericardium mounted in a nitinol stent, designed to simplify the implantation of an aortic valve. This metaanalysis evaluates the clinical, haemodynamic, and survival outcomes of the Perceval sutureless valve.Methods: An electronic search of 4 databases was performed from January 2000 to December 2016.Primary outcomes included mortality and stroke. Secondary outcomes included minimally invasive access, paravalvular leak, overall long-term survival, postoperative echocardiographic findings, and functional class improvement.Results: After the application of inclusion and exclusion criteria, 14 of 66 relevant articles were selected for assessment. Of these 14 studies, a total number of 2,505 patients were included. The current evidence on the Perceval valve for aortic valve disease is limited to observational studies only. Minimally invasive surgery was performed in 976 patients, of which 336 were via the right anterior thoracotomy approach. The Perceval M and L sutureless valves were the most frequently used, 782 and 770 respectively. The incidence of major adverse events included 30-day mortality (0 to 4.9%), cerebrovascular accident (0 to 3%), permanent pacemaker insertion (0 to 17%), moderate to severe paravalvular leak (0 to 8.6%), and re-operation (0 to 4.8%). Post-operative mean aortic valve gradient ranged from 9 to 15.9 mmHg and post-operative New York Heart Association (NYHA) Class I or II ranged from 82% to 96%. The 1-year survival ranged from 86% to 100%; and 5-year survival was 71.3% to 85.5% in two studies. Conclusions:The Perceval valve is associated with excellent post-operative results in MAVR and in conventional AVR. Larger randomised controlled studies are required to evaluate the long-term efficacy of the prosthesis.

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“…This reduces the incision from an average of 24.5 to 7.17 cm with a ministernotomy, or a 5 cm incision with a thoracotomy (13,14). MiniAVR has been shown to: reduce length of intensive care unit (ICU) and hospital stay, reduce ventilation time, decrease the need for blood transfusion, decrease pain, and improve the cosmetic result (15)(16)(17). A Cochrane review that included seven randomized controlled trials compared AVR via median sternotomy vs. were comparable between the minithoracotomy and ministernotomy groups, respectively (20).…”

Section: Miniavrmentioning

confidence: 99%

Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

Hoffmann

Heiner

Nguyen

2017

Ann. Cardiothorac. Surg.

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Transcatheter aortic valve replacement (TAVR) and minimally invasive aortic valve replacement (miniAVR) have become alternatives to surgical aortic valve replacement via median sternotomy (SAVR) to treat severe aortic stenosis (AS). Despite increased interest and utilization, few studies have directly compared TAVR and miniAVR. A review of the current literature shows TAVR to be an indispensable tool for inoperable, high-risk, and perhaps intermediate-risk patients with severe AS. However, it is associated with a number of deleterious perioperative outcomes, such as valvular regurgitation and vascular complications. MiniAVR is associated with decreased intensive care unit (ICU) and hospital length of stay, a lower incidence of blood transfusions, decreased ventilation time, and improved cosmetic results. MiniAVR maintains potential advantages over SAVR, including the implantation of a durable prosthesis and low rates of perioperative myocardial infarction and paravalvular leak. It is associated with longer aortic cross clamp and cardiopulmonary bypass (CPB) times; however, the use of sutureless valve implants can circumvent this. Studies comparing TAVR and miniAVR demonstrate decreased postoperative mortality, valvular regurgitation, and incidence of stroke in the miniAVR cohorts. Few studies currently exist comparing TAVR and miniAVR, as it is hard to compare the typically low-risk miniAVR versus high-risk TAVR patient populations. It is clear that both strategies will be cornerstones in the modern AVR era, but the situations in which to apply each strategy have not yet been clearly delineated. This highlights the need for surgeons to adopt these minimally invasive techniques. We believe there is a compelling role for miniAVR in low-and intermediate-risk patients, but due to the paucity of data, neither TAVR nor miniAVR should be discounted before a randomized, risk-stratified trial is performed. More studies are needed to compare TAVR and miniAVR in low-and intermediate-risk patients.

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Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis

Cited by 321 publications

References 34 publications

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Early results of the Sorin® Perceval S sutureless valve: systematic review and meta-analysis

Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

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