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

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.

scholarly journals Minimally Invasive versus Conventional Approach for Mitral Valve Surgery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A B ElKerdany ◽  
M A Elghanam ◽  
M A Gamal ◽  
T M E Abdelmoneim
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Standard Approach ◽  
Perioperative Outcomes

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.

scholarly journals What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

2016 ◽  
Vol 101 (3) ◽  
pp. 981-989 ◽  
Author(s):  
Marco Moscarelli ◽  
Khalil Fattouch ◽  
Roberto Casula ◽  
Giuseppe Speziale ◽  
Patrizio Lancellotti ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Observational Studies ◽  
Meta Analysis ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Totally endoscopic mitral valve surgery: early experience in 188 patients

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.

scholarly journals Tricuspid valve intervention at the time of mitral valve surgery: a meta-analysis

2019 ◽  
Vol 29 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Derrick Y Tam ◽  
Andrew Tran ◽  
Amine Mazine ◽  
Gilbert H L Tang ◽  
Mario F L Gaudino ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Observational Studies ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Pacemaker Implantation ◽  
Perioperative Period ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Late Mortality

Abstract OBJECTIVES The surgical management of tricuspid regurgitation (TR) at the time of mitral valve surgery remains controversial. Our objectives were to determine the safety and efficacy of tricuspid valve (TV) repair during mitral valve surgery in a meta-analysis. METHODS MEDLINE and EMBASE were searched from 1946 to 2017 for all studies comparing TV repair to no intervention at the time of mitral valve surgery on early and late mortality and late TR. A random-effects meta-analysis of all outcomes was performed. RESULTS One thousand four hundred and seventeen studies were retrieved and a total of 17 studies [2 randomized clinical trial (n = 211), 11 adjusted observational studies (n = 3848) and 4 unadjusted observational studies (n = 67 010)] that compared TV repair (n = 11 787) to no intervention (n = 56 027) at a mean follow-up of 6.0 ± 0.64 years were included. There was no difference in 30-day/in-hospital mortality between repair and no repair [risk ratio (RR) 1.19, 95% confidence interval (95% CI) 0.70–2.02; P = 0.52]. The incidence of new permanent pacemaker implantation was higher in the TV repair group (RR 2.73, 95% CI 2.57–2.89; P < 0.01). TV repair was protective against late moderate or greater TR [incident rate ratio (IRR) 0.28, 95% CI 0.17–0.47; P < 0.01] and severe TR (IRR 0.38, 95% CI 0.17–0.84). There was a numerically lower rate of late TV reoperation (IRR 0.39, 95% CI 0.12–1.25; P = 0.11) that did not reach statistical significance. Overall, there was no difference in late mortality between the 2 treatments (IRR 0.87, 95% CI 0.63–1.24; P = 0.43). CONCLUSIONS TV repair appears safe in the perioperative period and may reduce future recurrent TR without any survival benefit.

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