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

Moscarelli, Marco; Fattouch, Khalil; Casula, Roberto; Saglio, Giuseppe; Lancellotti, Patrizio; Athanasiou, Thanos

doi:10.1016/j.athoracsur.2015.08.050

Cited by 60 publications

(47 citation statements)

References 18 publications

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“…In patients undergoing CABG plus MV repair or replacement, the most common complication is new-onset atrial fibrillation, which occurs in 42.6% and 44.2%, respectively, and increases peri-operative morbidity and hospital length of stay (21,22). This figure is higher than the 16.1% noted in present cohort of PCI + MIMVS, and is consistent with prior studies suggesting a reduced incidence of post-operative atrial fibrillation when utilizing a minimally invasive approach for valve surgery (23,24). Similarly, prolonged mechanical ventilation occurred in 18.3% of the PCI + MIMVS cohort, with a reported incidence of 19.8% in CABG plus MV repair, and 29% in CABG plus MV replacement.…”

Section: Discussionsupporting

confidence: 39%

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

et al. 2017

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Background: The current study evaluated the safety and feasibility of staged ("hybrid") percutaneous coronary intervention (PCI) followed by isolated minimally invasive mitral valve (MV) surgery [PCI + minimally invasive mitral valve surgery (MIMVS)], for patients with concomitant coronary artery and MV disease. Results: There were 54 (58.1%) men and 39 (41.9%) women. The mean age was 73±8 years, and all patients had severe mitral regurgitation. PCI was performed for single-vessel coronary artery disease in 40 (43%) patients, two-vessel in 49 (52.7%), and three-vessel in 4 (4.3%). Within a median of 48 days (IQR, 18-71) after PCI, 78 (83.9%) patients underwent primary valve surgery, and 15 (16.1%) underwent re-operative valve surgery, with 56 (60.2%) having MV replacement, and 37 (39.8%) having MV repair.Sixty-five (69.9%) patients were being treated with dual anti-platelet therapy at the time of surgery. The median number of transfused intra-operative red blood cell units was 1 (IQR, 0-2), and the intensive care unit and hospital lengths of stay were 46 hours (IQR, 27-76) and 8 days (IQR, 5-11), respectively. Post-operatively, there was 1 (1.1%) cerebrovascular accident, 2 (2.2%) patients developed acute kidney injury, and 4 (4.3%) required a re-operation for bleeding. Thirty-day mortality occurred in 4 (4.3%) patients.At a mean follow-up of 15.3±13.2 months, 3 (3.4%) patients required target-vessel revascularization. The survival rate was 89% and 85% at 1 and 3 years, respectively. Conclusions:In patients with concomitant coronary artery and MV disease, PCI + MIMVS can be safely performed and is associated with good short-term and follow-up outcomes.

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Section: Discussionsupporting

confidence: 39%

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

et al. 2017

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“…It is clear that, in the future, cardiac surgeons will have to deal with an even larger number of elderly patients than today. These patients may be more prone to develop peri-operative adverse events [2], hence strategies that can ameliorate such outcomes are always sought.…”

Section: Introductionmentioning

confidence: 99%

“…Some of the aforementioned drawbacks may be related to technical reasons and/or learning curve; moreover, there are no prospective randomized trials so far, comparing in an unbiased way MIVS and sternotomy (ST) in a context of elderly. As such, the majority of evidences comes from observational studies [2].…”

Section: Introductionmentioning

confidence: 99%

The role of minimal access valve surgery in the elderly. A meta-analysis of observational studies

Moscarelli

Emmanuel

Athanasiou

et al. 2016

International Journal of Surgery

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h i g h l i g h t sMinimal access valve surgery is a safe alternative to the sternotomy approach in elderly patients. The approach demonstrates reduced mechanical ventilation time and reduced length of stay. Mortality is comparable to those undergoing a conventional sternotomy. Limitations for this approach include prolonged cardiopulmonary bypass and cross-clamp time.a r t i c l e i n f o b s t r a c tBackground: Minimal access valve surgery, both mitral and aortic, may be related to improvement in specific post-operative outcomes, therefore may be beneficial for the subgroup of the elderly referred for valve surgery. Methods: A systematic literature review identified several different studies, of which 6 fulfilled criteria for meta-analysis. Outcomes for a total of 1347 patients (675 conventional standard sternotomy and 672 minimally invasive valve surgery) were assessed with a meta-analysis using random effects modeling. Heterogeneity, subgroup analysis with quality scoring were also assessed. The primary endpoint was early mortality. Secondary endpoints included intra and post-operative outcomes. Results: In the context of elderly patients, minimal access valve surgery conferred comparable early mortality to standard sternotomy (odd ratio (OR) 0.79, CI [0.40,1.56], p ¼ 0.50) with no heterogeneity (p ¼ 0.13); it was also associated with reduced mechanical intubation time (OR 0.48, CI [0.30,0.78], p ¼ 0.003) and reduced post-operative length of stay (weighted mean difference (WMD) À2.91, CI [À3.09, À2.74] p < 0.00001), however both cardio-pulmonary bypass time and cross clamp time were longer (WMD 24.29, CI [22.97, 25.61] p < 0. 00001 and WMD 8.61, CI [7.61,9.61], p < 0.00001, respectively); subgroup analysis demonstrated statistically significant reduced post-operative length of stay for both minimally invasive aortic and mitral surgery (WMD À2.84, CI [À3.07, À2.60] p < 0.00001 and WMD À2.98, CI [À3.25, À2.71] p < 0.00001 respectively). Conclusions: Despite a prolonged cardiopulmonary bypass and cross clamp time, minimally invasive valve surgery is a safe alternative to standard sternotomy in the elderly, with similar early mortality, and improvements in intubation time as well as length of stay.

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“…The composite post-operative complications occurred in 29% of the MIVS group and 66% of the ST group (P=0.001), which was driven by a reduction in the incidence of prolonged mechanical ventilation (MIVS 15%, ST 55%, P<0.001). The median ICU and hospital LOS were [48 (IQR, vs. 118 (IQR, 67-167) hours, P<0.001] and [8 (IQR,[6][7][8][9][10][11][12] vs. 13 (IQR, 9-18) days, P=0.001] for the MIVS vs. ST group, respectively. Finally, operative mortality occurred in 2 (3%) in the MIVS and 4 (14%) in the ST group, P=0.07.…”

Section: Reoperative Mitral Surgerymentioning

confidence: 99%

Minimally invasive valve surgery in high-risk patients

et al. 2017

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The use of minimally, or less invasive, approaches to cardiac valve surgery has increased over the past decade. Because of its less traumatic nature, early studies in lower risk patients demonstrated the approach to be associated with an enhanced recovery, increased patient satisfaction, and good operative outcomes. With time, despite a steep learning curve, surgeons expanded this approach to perform more complex procedures, and include patients with more co-morbidity. The aim of this publication is to review the current literature involving the use of minimally invasive valve surgery (MIVS) in higher-risk patients.

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

Cited by 60 publications

References 18 publications

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

The role of minimal access valve surgery in the elderly. A meta-analysis of observational studies

Minimally invasive valve surgery in high-risk patients

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