A Meta-analysis Of Right Minithoracotomy Versus Median Sternotomy For Reoperative Mitral Valve Surgery
Nirav Patel, Jonathan Hemli, Karthik Seetharam, Ananmay Uttara, Joel Johnson, Iam Claire Sarmiento, Minal Patel, Derek Brinster, Luigi Pirelli, Chad Kliger, Efstathia Mihelis, Samuel Scheinerman.
Lenox Hill Hospital, New York, NY, USA.
Background: There is no clear consensus regarding the optimal approach for re-operative mitral valve surgery. Reoperative Mitral valve surgery is associated with high mortality and complications. Right minithoractomy is an alternative approach, there is a strong desire for less invasive surgery. We sought to conduct a meta-analysis analyzing recent studies comparing short-term complications between right minithoractomy (MT) versus median sternotomy (MS) for reoperative mitral valve surgery. Methods: We performed a comprehensive literature search from January 1st, 2002 to December 31st, 2019 for all eligible studies comparing right MT and MS in PubMed, EMBASE, SCOPUS, and Google Scholar. Clinical outcomes comprised of 30 day- mortality, stroke, re-operation for bleeding. Results: Seven single center studies were deemed eligible which consisted of 1033 patients which consisted of 327 right MTand 706 MS patients. There was no statistical difference between right MT and MS for stroke (OR 1.33, 95% CI 0.59- 3.00, p= 0.50). The reoperation for bleeding was close to significant and lower for right MT (OR 0.41, 95% 0.16- 1.06, p= 0.07). Right MT was associated with lower mortality (OR 0.40, 95%, Cl 0.19- 0.86 0.57, P= 0.02) Conclusion: Right MT has a lower mortality and close to significant lower reoperation for bleeding compared to MS. Stroke is similar between both approaches.
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