Minimally Invasive or Conventional Sternotomy for Mitral Valve Surgery With Concomitant Surgical Ablation for Atrial...

Area of Science:

• Cardiovascular Surgery
• Cardiac Arrhythmia Management
• Minimally Invasive Techniques

Background:

• Limited availability of single-stage surgical correction for mitral valve disease and atrial fibrillation (AF) using mini-access.
• Poorly understood comparative effectiveness of mini-access versus conventional sternotomy (CS) for combined procedures.

Purpose of the Study:

• To compare the efficacy and safety of concomitant mitral valve surgery and AF ablation via a minimally invasive approach (MICS) versus a conventional sternotomy (CS) approach.

Main Methods:

• Extensive literature search to identify relevant studies.
• Inclusion of studies comparing MICS and CS for combined mitral valve surgery and AF ablation.
• Meta-analysis of efficacy and safety outcomes.

Main Results:

• No significant differences in freedom from atrial arrhythmia (AA) at 1 and 2 years between MICS and CS groups.
• Significantly longer cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times in the MICS group (p < 0.001).
• Lower rate of pacemaker implantation in the MICS group compared to CS (p < 0.001).

Conclusions:

• Minimally invasive approach is associated with longer CPB and ACC times.
• No significant differences in mortality or freedom from AA at 1 and 2 years.
• Minimally invasive surgery demonstrates a lower rate of pacemaker implantation.