Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta‐analysis

Abstract Introduction Full median sternotomy has been well established as a standard approach for all types of open heart surgery for many years. Although well established, the full sternotomy incision has been frequently criticized for its length, post operative pain and possible complications. Minimally invasive mitral valve surgery can be an appealing feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. We here made meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease. Methods A systematic review of studies comparing perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane Collaboration) was employed to analyze the results. The outcomes of interest are mortality, cerebrovascular accidents, wound infection, reexploration due to bleeding, and LVEF assessment post-surgery. Results 12 studies involving 10279 patients were included in the meta-analysis. The 30-day mortality was significantly decreased with MIMVS; 1.6% in the MIMVS group and 2.9% in the group treated through a conventional sternotomy. Cerebrovascular events were significantly decreased with MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients treated via a conventional sternotomy. Wound infections, reexploration due to bleeding, and LVEF did not differ significantly between both groups. Conclusion The perioperative outcome is more or less similar for minimally invasive mitral valve surgery and conventional mitral valve surgery performed via median sternotomy. Given balance in outcomes, MIMVS is at least as safe as the standard approach and can be considered a routine and standard approach for mitral valve surgery.

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Minimally invasive (mini-thoracotomy) versus median sternotomy in redo mitral valve surgery: A meta-analysis of observational studies

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321997084 ◽

2021 ◽

pp. 021849232199708

Author(s):

Azhar Hussain ◽

Jacob Chacko ◽

Mohsin Uzzaman ◽

Osama Hamid ◽

Salman Butt ◽

...

Keyword(s):

Mitral Valve ◽

Length Of Stay ◽

Minimally Invasive ◽

Hospital Mortality ◽

Observational Studies ◽

Meta Analysis ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Mini Thoracotomy

Objective Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery. Method The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I2-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients. Results There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups. Conclusion Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.

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Minimally invasive triple valve surgery through partial upper sternotomy: Early results are promising

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332437 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

PS Risteski ◽

N Monsefi ◽

E Srndic ◽

T Josic ◽

UA Stock ◽

...

Keyword(s):

Minimally Invasive ◽

Valve Surgery ◽

Early Results ◽

Triple Valve

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Totally endoscopic mitral valve surgery: early experience in 188 patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01464-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yi Chen ◽

Ling-chen Huang ◽

Dao-zhong Chen ◽

Liang-wan Chen ◽

Zi-he Zheng ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Disease ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Disease ◽

Endoscopic Technique ◽

Venous Cannula ◽

Defect Repair

Abstract Introduction Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. Material and methods We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. Results A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. Conclusions The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.

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Minimally invasive triple valve surgery: The Rome approach

10.1510/mmcts.2018.056 ◽

2018 ◽

Keyword(s):

Minimally Invasive ◽

Valve Surgery ◽

Triple Valve

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GW27-e0624 Minimally Invasive Versus Conventional Median Sternotomy in Mitral Valve Repair Patients: a systematic review and meta-analysis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.07.610 ◽

2016 ◽

Vol 68 (16) ◽

pp. C162

Author(s):

Xu Zhe ◽

Jin Fan ◽

Mei Jiang ◽

Miao-na Tan ◽

Shao-Hong Ma ◽

...

Keyword(s):

Systematic Review ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Meta Analysis ◽

Median Sternotomy ◽

Valve Repair

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Sternotomy-Free Minimally Invasive Aortic Valve Surgery as a Single, Double, or Triple Valve Procedure

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1598904 ◽

2017 ◽

Vol 65 (S 01) ◽

pp. S1-S110

Author(s):

G. Färber ◽

S. Tkebuchava ◽

C. Sponholz ◽

M. Diab ◽

T. Doenst

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Triple Valve

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Ministernotomy: A preliminary experience in heart valve surgery

Vojnosanitetski pregled ◽

10.2298/vsp1105405k ◽

2011 ◽

Vol 68 (5) ◽

pp. 405-409

Author(s):

Pavle Kovacevic ◽

Bogoljub Mihajlovic ◽

Lazar Velicki ◽

Aleksandar Redzek ◽

Vladimir Ivanovic ◽

...

Keyword(s):

Postoperative Complications ◽

Mitral Valve ◽

Minimally Invasive ◽

Median Sternotomy ◽

Valve Surgery ◽

Site Infection ◽

Duration Of Hospital Stay ◽

Extubation Time ◽

Postoperative Drainage ◽

Cerebrovascular Insult

Background/Aim. The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 ? 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 ? 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ? 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 ? 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full sternotomy surgical approach.

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