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Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A Systematic Review and Meta-Analysis

Ali Hage1,2, Fadi Hage1,2, Hussein Al-Amodi1

  • 1622170384 Western University, London, ON, Canada.

Innovations (Philadelphia, Pa.)
|March 30, 2021
PubMed
Abstract

Insights

Minimally invasive mitral valve surgery (MIMVS) in elderly patients shows fewer complications and shorter hospital stays compared to conventional sternotomy (CS). However, MIMVS involves longer cross-clamp and bypass times, with similar mortality rates.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Procedures

Background:

  • The safety and efficacy of minimally invasive mitral valve surgery (MIMVS) in elderly patients (≥65 years) remain subjects of ongoing debate.
  • Conventional sternotomy (CS) is the traditional approach for mitral valve surgery.

Purpose of the Study:

  • To systematically review and meta-analyze existing studies comparing MIMVS with CS in elderly patients undergoing mitral valve surgery.
  • To evaluate postoperative outcomes, including complications, length of stay, and procedural times.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, EMBASE, Web of Science) and clinical trial registries.
  • Included were randomized controlled trials and observational studies comparing MIMVS and CS in patients aged 65 and older.
  • A random-effects meta-analysis was performed to synthesize data on various outcomes.

Main Results:

  • MIMVS was associated with significantly lower odds of acute renal failure, prolonged intubation, and reduced need for blood product transfusion.
  • Patients undergoing MIMVS experienced shorter intensive care unit (ICU) and hospital lengths of stay (LOS).
  • No significant differences were observed in mortality, stroke, respiratory infection, reoperation for bleeding, or postoperative atrial fibrillation rates. MIMVS did involve longer cross-clamp and cardiopulmonary bypass times.

Conclusions:

  • Minimally invasive mitral valve surgery (MIMVS) offers significant advantages in reducing postoperative complications and hospital LOS for elderly patients compared to conventional sternotomy (CS).
  • Despite longer procedural times (cross-clamp and bypass), MIMVS demonstrates a favorable safety profile in this demographic.
  • These findings support the consideration of MIMVS as a viable option for elderly patients requiring mitral valve surgery.
Keywords:
meta-analysisminimally invasivemitral surgery

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