Minimally Invasive Versus Conventional Aortic Root Replacement: A Review And Meta-analysis
Diamantis I. Tsilimigras1, Oleg Orlov1, Cinthia Orlov1, Meghan Buckley2, Serge Sicouri3, Konstandinos Plestis1.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Lankenau Institute for Medical Research, Wynnewood, PA, USA, 3Lankenau Institute for Medical Resarch, Wynnewood, PA, USA.
Objective: A minimally invasive sternotomy (MS) has been proposed as an alternative to conventional full sternotomy (FS) aortic surgery. The objective of this study was to perform a review and meta-analysis of studies comparing intraoperative and postoperative outcomes of patients undergoing aortic root surgery by either MS or FS using the mini-Bentall procedure. Methods: We searched the PubMed database to identify studies that compare the outcomes of patients undergoing MS vs FS surgery for aortic root replacement by applying the following algorithm: "(((aortic root) AND (replacement OR surgery OR reconstruction)) AND ((minimally invasive) OR (mini-sternotomy OR ministernotomy OR mini-thoracotomy OR minithoracotomy))) OR ((mini-Bentall) OR (mini Bentall))." Results: A total of four studies including 343 patients compared the outcomes of patients undergoing MS vs FS using the mini-Bentall approach in aortic root surgery. No significant differences were observed between MS and FS in terms of aortic cross clamp time (p = 0.152), blood utilization (p = 0.152), reoperation from bleeding (p = 0.530) ), prolonged ventilatory support (p = 0.495), renal failure (p = 0.665), length of ICU stay (p = 0.853), hospital stay (p =0.235), permanent pacemaker implantation (p= 0.400), as well as 30-day/in-hospital mortality (p = 0.559) (Fig 1). MS was associated with significantly shorter operation time (p = 0.001), shorter cardiopulmonary bypass time (p< 0.001) and less post-operative atrial fibrillation (p = 0.041). Conclusion: This meta-analysis suggests that minimally invasive aortic root surgery is safe and has similar or better outcomes compared to conventional aortic root replacement surgery. Larger comparative studies are needed to support the available data.
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