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Mini-Sternotomy vs. Right Anterior Mini-Thoracotomy for Surgical Aortic Valve Replacement - A Systematic Review and
Dimitrios Starvridis1, Arian Arjomandi Rad2, Paola Keese Montanhesi3
1Department of Cardiothoracic Surgery, University Clinic Magdeburg, Magdeburg, Germany.
Brazilian Journal of Cardiovascular Surgery
|March 19, 2025
Summary
Minimally invasive aortic valve replacement via mini-sternotomy or right anterior mini-thoracotomy shows similar mortality. Right anterior mini-thoracotomy has increased bleeding reoperations but fewer strokes, with longer operation times.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Minimally invasive aortic valve replacement (AVR) is gaining traction.
- Mini-sternotomy and right anterior mini-thoracotomy are common approaches.
- Comparative outcomes data are crucial for surgical decision-making.
Purpose of the Study:
- To compare clinical outcomes of mini-sternotomy versus right anterior mini-thoracotomy for AVR.
- To evaluate perioperative mortality and secondary endpoints.
- To synthesize evidence from existing literature.
Main Methods:
- A systematic literature review and meta-analysis were conducted.
- Data were extracted from three databases.
- Random effects models were used to analyze outcomes.
Main Results:
- Ten studies with 30,524 patients were included.
- No significant difference in perioperative mortality was observed between the two approaches.
- Right anterior mini-thoracotomy was associated with higher reoperation for bleeding rates (OR 0.69) and lower stroke rates (OR 1.27), but longer operation duration (SMD -0.58).
Conclusions:
- Both mini-sternotomy and right anterior mini-thoracotomy offer comparable perioperative mortality for AVR.
- Right anterior mini-thoracotomy presents a trade-off: increased bleeding risk but reduced stroke incidence.
- Surgical planning should consider these specific outcome differences.
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