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Related Experiment Videos

Limited versus full sternotomy for aortic valve replacement.

Bilal H Kirmani1, Sion G Jones1, S C Malaisrie2

  • 1Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, Merseyside, UK, L14 3PE.

The Cochrane Database of Systematic Reviews
|April 11, 2017
PubMed
Summary

Minimally invasive aortic valve replacement (AVR) via limited sternotomy shows potential benefits like reduced blood loss and shorter ICU stays. However, evidence quality is low to moderate, necessitating further research for definitive conclusions on safety and efficacy compared to conventional median sternotomy.

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Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Procedures
  • Aortic Valve Replacement

Background:

  • Aortic valve disease is treatable with cardiac surgery, conventionally via median sternotomy.
  • Minimally invasive approaches using limited sternotomy are emerging, raising questions about their safety and efficacy.
  • Concerns exist regarding surgical access, cannulation, and heart management in minimally invasive AVR.

Purpose of the Study:

  • To compare the effects of minimally invasive aortic valve replacement (AVR) via limited sternotomy versus conventional AVR via median sternotomy.
  • To assess patient-relevant outcomes including mortality, operative times, and postoperative complications.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).

Related Experiment Videos

  • Searches included CENTRAL, MEDLINE, Embase, and clinical trials registries up to July 2016.
  • Excluded trials using other minimally invasive techniques (e.g., mini-thoracotomies, robotic procedures).

    • Main Results:

    • Seven RCTs with 511 participants were included.
    • No significant differences in mortality, cardiopulmonary bypass time, or aortic cross-clamp time were found.
    • Minimally invasive AVR showed lower postoperative blood loss and shorter intensive care unit (ICU) stays, but evidence quality was low to moderate.
    • No significant reduction in deep sternal wound infections, re-exploration, or pain scores was observed.

    Conclusions:

    • Current evidence is of generally low to moderate quality, with small sample sizes limiting definitive conclusions.
    • Uncertainty remains regarding the effects of limited sternotomy AVR on mortality, operative times, and secondary outcomes.
    • A well-designed, adequately powered RCT is needed to establish the efficacy and safety of minimally invasive AVR, including cost-effectiveness and quality-of-life analyses.