Mini-sternotomy vs right anterior thoracotomy for aortic valve replacement

Area of Science:

• Cardiac Surgery
• Minimally Invasive Procedures
• Aortic Valve Replacement

Background:

• Minimally invasive aortic valve replacement (AVR) techniques are increasingly used.
• Limited comparative data exist for different minimally invasive AVR approaches.
• This study compares mini-sternotomy (MS) and right anterior thoracotomy (RAT) for AVR.

Purpose of the Study:

• To compare short-term outcomes between mini-sternotomy (MS) and right anterior thoracotomy (RAT) for aortic valve replacement (AVR).
• To identify potential differences in operative mortality, complications, and resource utilization.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, and OVID (1990-2019).
• Inclusion of nine observational studies with 2926 patients.
• Meta-analysis of outcomes including mortality, reoperation, cross-clamp time, pacemaker insertion, stroke, atrial fibrillation, infection, and length of stay.

Main Results:

• No significant difference in operative mortality between MS and RAT.
• MS was favored for reduced reoperation for bleeding and shorter aortic cross-clamp time.
• RAT was associated with a shorter length of hospital stay and borderline shorter postoperative ventilation.
• Rates of stroke, atrial fibrillation, and surgical site infection were similar between groups.

Conclusions:

• Significant short-term outcome differences exist between MS and RAT for AVR.
• Mini-sternotomy may offer advantages in specific complications and procedure time.
• Right anterior thoracotomy may lead to faster recovery in terms of hospital stay.
• Findings have implications for patient selection, particularly in the elderly.