Marco Moscarelli1, Khalil Fattouch2, Roberto Casula3, Giuseppe Speziale4, Patrizio Lancellotti5, Thanos Athanasiou3. 1. National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: m.moscarelli@imperial.ac.uk. 2. GVM Care and Research, Villa Maria Eleonora, Palermo, Italy. 3. Department of Surgery and Cancer, Imperial College London, London, United Kingdom. 4. GVM Care, Anthea Hospital, Bari, Italy. 5. Department of Cardiology, University of Liège Hospital, Liege, Belgium; and the GVM Care and Research Group.
Abstract
BACKGROUND: Minimally invasive valve surgery is related to certain better postoperative outcomes. We aimed to assess the role of minimally invasive mitral valve surgery in high-risk patients. METHODS: A systematic literature review identified eight studies of which seven fulfilled criteria for meta-analysis. Outcomes for a total of 1,254 patients (731 were conventional standard sternotomy and 523 were minimally invasive mitral valve surgery) were submitted to meta-analysis using random effects modeling. Heterogeneity and subgroup analysis with quality scoring were assessed. The primary end point was early mortality. Secondary end points were intraoperative and postoperative outcomes and long-term follow-up. RESULTS: Minimally invasive mitral valve surgery conferred comparable early mortality to standard sternotomy (p = 0.19); it was also associated with a lower number of units of blood transfused (weighted mean difference, -1.93; 95% confidence interval [CI], -3.04 to -0.82; p = 0.0006) and atrial fibrillation rate (odds ratio, 0.49; 95% CI, 0.32 to 0.74; p = 0.0007); however, cardiopulmonary bypass time was longer (weighted mean difference, 20.88; 95% CI, -1.90 to 43.65; p = 0.07). There was no difference in terms of valve repair rate (odds ratio, 1.51; 95% CI, 0.89 to 2.54; p = 0.12), and the incidence of stroke was significantly lower in the high-quality analysis with no heterogeneity (odds ratio, 0.35; 95% CI, 0.15 to 0.82; p = 0.02; χ(2), 1.67; I(2), 0%; p = 0.43). CONCLUSIONS: Minimally invasive mitral valve surgery is a safe and comparable alternative to standard sternotomy in patients at high risk, with similar early mortality and repair rate and better postoperative outcomes, although a longer cardiopulmonary bypass time is required.
BACKGROUND: Minimally invasive valve surgery is related to certain better postoperative outcomes. We aimed to assess the role of minimally invasive mitral valve surgery in high-risk patients. METHODS: A systematic literature review identified eight studies of which seven fulfilled criteria for meta-analysis. Outcomes for a total of 1,254 patients (731 were conventional standard sternotomy and 523 were minimally invasive mitral valve surgery) were submitted to meta-analysis using random effects modeling. Heterogeneity and subgroup analysis with quality scoring were assessed. The primary end point was early mortality. Secondary end points were intraoperative and postoperative outcomes and long-term follow-up. RESULTS: Minimally invasive mitral valve surgery conferred comparable early mortality to standard sternotomy (p = 0.19); it was also associated with a lower number of units of blood transfused (weighted mean difference, -1.93; 95% confidence interval [CI], -3.04 to -0.82; p = 0.0006) and atrial fibrillation rate (odds ratio, 0.49; 95% CI, 0.32 to 0.74; p = 0.0007); however, cardiopulmonary bypass time was longer (weighted mean difference, 20.88; 95% CI, -1.90 to 43.65; p = 0.07). There was no difference in terms of valve repair rate (odds ratio, 1.51; 95% CI, 0.89 to 2.54; p = 0.12), and the incidence of stroke was significantly lower in the high-quality analysis with no heterogeneity (odds ratio, 0.35; 95% CI, 0.15 to 0.82; p = 0.02; χ(2), 1.67; I(2), 0%; p = 0.43). CONCLUSIONS: Minimally invasive mitral valve surgery is a safe and comparable alternative to standard sternotomy in patients at high risk, with similar early mortality and repair rate and better postoperative outcomes, although a longer cardiopulmonary bypass time is required.
Authors: Orlando Santana; Steve Xydas; Roy F Williams; Angelo LaPietra; Maurice Mawad; Frederick Hasty; Esteban Escolar; Christos G Mihos Journal: J Thorac Dis Date: 2017-06 Impact factor: 2.895
Authors: Orlando Santana; Steve Xydas; Roy F Williams; Maurice Mawad; Todd B Heimowitz; Andrés M Pineda; Howard S Goldman; Christos G Mihos Journal: J Thorac Dis Date: 2017-06 Impact factor: 2.895
Authors: Orlando Santana; Steve Xydas; Roy F Williams; S Howard Wittels; Evin Yucel; Christos G Mihos Journal: J Thorac Dis Date: 2017-06 Impact factor: 2.895
Authors: Jan-Philipp Minol; Payam Akhyari; Udo Boeken; Alexander Albert; Philipp Rellecke; Vanessa Dimitrova; Stephan Urs Sixt; Hiroyuki Kamiya; Artur Lichtenberg Journal: Front Surg Date: 2018-02-09