Mini-Sternotomy vs. Right Anterior Mini-Thoracotomy for Surgical Aortic Valve Replacement - A Systematic Review and Meta-Analysis.

INTRODUCTION

Minimally invasive techniques for aortic valve replacement have become increasingly popular. The most common minimally invasive approaches are mini-sternotomy and right anterior mini-thoracotomy. We aimed to review the literature and compare clinical outcomes for these two approaches.

METHODS

Three databases were assessed. The primary endpoint was perioperative mortality. The secondary endpoints were reoperation for bleeding, stroke, operation duration, intensive care unit length of stay, cardiopulmonary bypass time, cross-clamping time, hospital length of stay, paravalvular leak, renal complications, conversion to full sternotomy, permanent pacemaker implantation, and wound infection. Random effects models were performed.

RESULTS

Ten studies were included in the meta-analysis (30,524 patients). There was no difference in perioperative mortality between groups (odds ratio: 0.83; 95% confidence interval 0.57-1.21; P=0.33). In comparison with mini-sternotomy, right anterior mini-thoracotomy showed higher rates of reoperation for bleeding (odds ratio: 0.69; 95% confidence interval 0.50-0.97; P=0.03), lower rates of stroke (odds ratio: 1.27; 95% confidence interval 1.01-1.60; P=0.04), and longer operation duration (standard mean difference: -0.58; 95% confidence interval -1.01 to -0.14; P=0.01). Other secondary endpoints were not statistically significant.

CONCLUSION

The results suggest that both techniques present similar perioperative mortality rates for aortic valve replacement. However, right anterior mini-thoracotomy is associated with higher rates of reoperation for bleeding, lower rates of stroke, and longer operation duration time.