Michel Pompeu B O Sá1, Jef Van den Eynde2, Luiz Rafael P Cavalcanti1, Bakytbek Kadyraliev3, Soslan Enginoev4,5, Konstantin Zhigalov6, Arjang Ruhparwar6, Alexander Weymann6, Gilles Dreyfus7. 1. Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil. 2. Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium. 3. Department of Cardiac Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russia. 4. Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia. 5. Department of Cardiovascular Surgery, Astrakhan State Medical University, Astrakhan, Russia. 6. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany. 7. Department of Cardiac Surgery, Institut Montsouris, University Pierre et Marie Curie, Paris, France.
Abstract
BACKGROUND AND AIM OF THE STUDY: Minimally invasive cardiac surgery (MICS) for mitral valve repair (MVRp) has been increasingly used. This study aimed to evaluate the early and late results of MICS for MVRp vs conventional sternotomy. MATERIALS AND METHODS: A systematic review of randomized controlled trials or observational studies (with matched populations) comparing MICS and conventional MVRp reporting any of the following outcomes: mortality, MVRp failure, complications, blood transfusion, readmission within 30 days after discharge, long-term reoperation for mitral regurgitation, operative times, mechanical ventilation time, intensive care unit (ICU) stay, or hospital stay. The pooled treatment effects were calculated using a random-effects model. RESULTS: Ten studies involving 6792 patients (MICS: 3396 patients; Conventional: 3296 patients) met the eligibility criteria. In the pooled analysis, MICS significantly reduced the risk for blood transfusion (odds ratio [OR], 0.654; 95% confidence interval [CI] 0.462-0.928; P = .017) and readmission within 30 days after discharge (OR, 0.615; 95% 0.456-0.829; P = .001). MICS was associated with a significantly longer cross-clamp time (mean difference 14 minutes; 95% CI, 7.4-21 minutes; P < .001), CPB time (24 minutes; 95% CI, 14-35 minutes; P < .001), and total operative time (36; 95% CI, 15-56 minutes; P < .001), but a significantly shorter ICU stay (-8.5; 95% CI -15; -1.8; P = .013) and hospital stay (-1.3, 95% CI -2.1; -0.45; P = .003). This meta-analysis found no significant difference regarding the risk of in-hospital and long-term mortality, nor complications. CONCLUSIONS: Despite longer operative times, MICS for MVRp reduces ICU and hospital stay, as well as readmission rates and the need for transfusion.
BACKGROUND AND AIM OF THE STUDY: Minimally invasive cardiac surgery (MICS) for mitral valve repair (MVRp) has been increasingly used. This study aimed to evaluate the early and late results of MICS for MVRp vs conventional sternotomy. MATERIALS AND METHODS: A systematic review of randomized controlled trials or observational studies (with matched populations) comparing MICS and conventional MVRp reporting any of the following outcomes: mortality, MVRp failure, complications, blood transfusion, readmission within 30 days after discharge, long-term reoperation for mitral regurgitation, operative times, mechanical ventilation time, intensive care unit (ICU) stay, or hospital stay. The pooled treatment effects were calculated using a random-effects model. RESULTS: Ten studies involving 6792 patients (MICS: 3396 patients; Conventional: 3296 patients) met the eligibility criteria. In the pooled analysis, MICS significantly reduced the risk for blood transfusion (odds ratio [OR], 0.654; 95% confidence interval [CI] 0.462-0.928; P = .017) and readmission within 30 days after discharge (OR, 0.615; 95% 0.456-0.829; P = .001). MICS was associated with a significantly longer cross-clamp time (mean difference 14 minutes; 95% CI, 7.4-21 minutes; P < .001), CPB time (24 minutes; 95% CI, 14-35 minutes; P < .001), and total operative time (36; 95% CI, 15-56 minutes; P < .001), but a significantly shorter ICU stay (-8.5; 95% CI -15; -1.8; P = .013) and hospital stay (-1.3, 95% CI -2.1; -0.45; P = .003). This meta-analysis found no significant difference regarding the risk of in-hospital and long-term mortality, nor complications. CONCLUSIONS: Despite longer operative times, MICS for MVRp reduces ICU and hospital stay, as well as readmission rates and the need for transfusion.
Authors: Waqas Ullah; Sajjad Gul; Sameer Saleem; Mubbasher Ameer Syed; Muhammad Zia Khan; Salman Zahid; Abdul Mannan Khan Minhas; Salim S Virani; Mamas A Mamas; David L Fischman Journal: Eur Heart J Open Date: 2022-01-13
Authors: Michael L Williams; Bridget Hwang; Linna Huang; Ashley Wilson-Smith; John Brookes; Aditya Eranki; Tristan D Yan; T Sloane Guy; Johannes Bonatti Journal: Ann Cardiothorac Surg Date: 2022-09