Comparison of perioperative outcomes of minimally invasive and conventional aortic root surgery in adult patients: a systematic review and meta-analysis.

INTRODUCTION

Minimally invasive approaches have become a gold standard for most cardiac surgery procedures, but their use in aortic root surgery remains limited. Previous analyses suggested potential benefits of minimally invasive aortic root surgery (MIARS) over conventional aortic root surgery (CARS). This study aims to provide updated insights into intraoperative and early postoperative outcomes between MIARS and CARS.

METHODS

. This systematic review and meta-analysis followed PRISMA guidelines. Two-arm observational studies comparing MIARS and CARS were included. The literature search was conducted using a mix of keywords and standardized indexing terms in the eight sources up to December 16, 2024. The risk of bias was assessed using ROBINS-I.

RESULTS

Twenty-one studies comparing MIARS and CARS were included, resulting in 2908 MIARS and 3,456 CARS patients. Minimally invasive approaches were associated with shorter mechanical ventilation (−4.72 h; p < .001), ICU stay (−0.46 days; p < .001), hospital stay (−1.65 days; p < .001), reduced postoperative bleeding (−0.82 units; p < .001), blood transfusion (−0.50 units; p < .001) and atrial fibrillation rate (RR 0.73; p = .006). Safety outcomes, including the risk of mortality, stroke, and renal failure, as well as surgical procedure duration, reflected by aortic cross-clamp and cardiopulmonary bypass times, were comparable between MIARS and CARS.

CONCLUSION

The use of minimally invasive approaches for aortic root procedures may offer benefits over median sternotomy, including shorter recovery times and reduced postoperative bleeding, without compromising safety. However, the certainty of the available evidence remains low.