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

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.

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.

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 = 0.50) with no heterogeneity (p = 0.13); it was also associated with reduced mechanical intubation time (OR 0.48, CI [0.30,0.78], p = 0.003) and reduced post-operative length of stay (weighted mean difference (WMD) -2.91, CI [-3.09, -2.74] 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 -2.84, CI [-3.07, -2.60] p < 0.00001 and WMD -2.98, CI [-3.25, -2.71] p < 0.00001 respectively).

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.