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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Minimally invasive versus conventional aortic valve replacement: The network meta-analysis
Takuya Ogami1, Yujiro Yokoyama2, Hisato Takagi3
1Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Journal of Cardiac Surgery
|November 15, 2022
Summary
Minimally invasive mini-sternotomy (MS) offers potentially better short-term outcomes for surgical aortic valve replacement (SAVR) compared to full sternotomy (FS) or right mini-thoracotomy (RMT). Mid-term mortality was similar across all surgical aortic valve replacement approaches.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Conflicting outcomes reported for surgical aortic valve replacement (SAVR) comparing minimally invasive approaches (mini-sternotomy [MS], right mini-thoracotomy [RMT]) with full sternotomy (FS).
- Lack of synthesized mid-term mortality data for these SAVR approaches.
Purpose of the Study:
- To compare outcomes of SAVR across FS, MS, and RMT incisional approaches.
- To synthesize mid-term mortality data for SAVR procedures.
Main Methods:
- Systematic literature search of MEDLINE and EMBASE up to April 2022.
- Inclusion of propensity score matched (PSM) studies and randomized controlled trials (RCTs).
- Network analysis using a random effects model to compare FS, MS, and RMT outcomes.
Main Results:
- Analysis of 42 studies with 14,925 patients.
- Lower operative mortality observed with MS compared to FS and RMT.
- Higher risk of reoperation for bleeding with RMT versus MS.
- Shorter hospital length of stay with MS compared to FS; no significant difference between FS and RMT.
- Similar mid-term (1-year) mortality across all three approaches.
Conclusions:
- Mini-sternotomy (MS) may be a safer and more effective short-term approach for SAVR than full sternotomy (FS) or right mini-thoracotomy (RMT).
- Mid-term mortality is comparable among the three SAVR incisional approaches.
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