Minimally invasive approach versus median sternotomy in patients undergoing surgery for mitral valve infective endocarditis, a meta-analysis.

ObjectiveWe aimed to compare early and late postoperative clinical outcomes between minimally invasive surgery (MIS) and full sternotomy (FS) in patients with mitral valve (MV) infective endocarditis (IE).MethodsThis meta-analysis was conducted in compliance with the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched for any randomized control trials or cohort studies that compared MIS versus FS in surgery for mitral valve infective endocarditis.ResultsFour cohort studies with 466 patients (137 in MIS group and 329 in FS group), were included in our study. Pooled analysis showed no significant difference between MIS and FS in terms of in-hospital/30-day mortality (RR = 0.71, 95% CI [0.31-1.60], p-value = 0.40), stroke (RR = 0.63, 95% CI [0.16-2.46], p-value = 0.50), atrial fibrillation (RR = 0.89, 95% CI [0.57-1.40], p-value = 0.62), acute kidney injury/renal failure (RR = 0.51, 95% CI [0.22-1.16], p-value = 0.11), multi-organ failure (RR = 0.94, 95% CI [0.33-2.70], p-value = 0.90), and readmission rates (RR = 0.75, 95% CI [0.39-1.45], p-value = 0.39). However, our study showed a statistically significant association between MIS and lower risk of postoperative sepsis (RR = 0.17, 95% CI [0.03-0.84], p-value = 0.03), fewer blood transfusions (RR = 0.63, 95% CI [0.48-0.84], p-value = 0.001), and shorter length of ICU stay (RR = -1.57, 95% CI [-2.16, -0.97], p-value <0.00001) compared to FS. The pooled effect estimate showed no significant difference between both groups in terms of need for reoperation, permanent pacemaker implantation, survival up to 2.5 years, and IE recurrence up to 3.5 years.ConclusionsOur findings suggest that MIS may be a safe and cost-effective alternative for FS in patients undergoing surgery for mitral valve infective endocarditis. Surgical approach should be tailored to the patient's clinical risk profile, the extent of endocarditis, and the team's experience, to ensure optimal clinical outcomes.