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Minimally invasive mitral surgery versus sternotomy approach. A meta analysis of “statistically sound” studies
MASSIMO MECO, ENRICO GIUSTINIANO, PAOLO PANISI, SILVIA CIRRI, ANTONIO MICELI, MATTIA GLAUBER.
ICSA MILAN, milan, Italy.

OBJECTIVE: . The purpose of this study was to evaluate the postoperative, midterm, and long term results of minimally invasive mitral surgery (MIMS) versus classical sternotomy approach (SMS).
METHODS: In order to minimize possible bias, we decided to use for our meta-analysis, only "statistically sound" studies, in practice studies that had used at least one patients’ matching technique. Potentially eligible trials were identified by searching the Medline, Embase, Scopus, ISI Web of Knowledge and The Cochrane Library. Searches were not restricted by language or publication status and were updated in October 2015. Statistically sound studies comparing MIMS and SMS were identified.
The primary end point were postoperative mortality, postoperative renal failure, postoperative pulmonary failure, postoperative neurological complications, cardiopulmonary bypass and cross clamping times, secondary end points were midterm and long term survival. Dichotomous data were summarized using risk ratio with a 95% confidence interval. Heterogeneity was quantified with the I2 statistic. Publication bias was assessed using a funnel plot and Begg’s asymmetry test.
RESULTS: Six trials met the inclusion criteria. A total of 4,272 patients (2136 in MIMS group and 2136 in SMS group) were enrolled in this meta analysis. We found no difference in 30-day mortality (1.07% vs 1.07%, OR 1.04 C.I. 95% 0.56-1.91 p=0.91), in postoperative renal failure (1.63% vs 1.96% OR 0.83 C.I. 95% 0.52-1.31 p=0.42), in postoperative pulmonary complications (4.23% vs 4.28% OR 1.02 C.I. 95% 0.62-1.66 p=0.95), and in postoperative cerebrovascular complications (1.02% vs 1.35% OR 0.78 C.I. 95% 0.44-1.37 p=0.39). Both cardiopulmonary bypass time, and aortic cross clamp time were longer in MIMS group ( MD 30.13 (17.90-42.36) p<0.001, and MD 14.25 (6.14-22.37) p<0.001) Follow-up data were similar between the two groups (1 year survival 96.3%+1.24% vs 95.6+1.24 OR 0.99 p=0.83, 3 years survival 95.3%+0.62% vs 94.3%+1.24% OR 1.23 p=0.42, 5 years survival 93.6%+2.05 vs 91%+1.41 OR 0.76 p=0.41, 7 years survival 81.5%+4.5% vs 81%+3 OR 1.07 p=0.85)
CONCLUSIONS: Minimally invasive mitral valve surgery is safe. Also mid term, and long term results are similar between minimally invasive and sternotomy approach.


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