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Minimally Invasive Versus Conventional Sternotomy For Primary Benign Tumours: A Meta-analysis
Mohammed M. Uzzaman, Alessia Rossi, Alberto Albanese, Ahmed Shazly, Yassir Iqbal, Sudhir Bhusari, Arvind Singh, Hasnat Khan;
Basildon University Hospital, Basildon, United Kingdom
BACKGROUND:The contemporary trend towards more minimally invasive approach in general cardiac surgery have extended to involve resection of primary benign cardiac tumours, particularly in the hands of experienced surgeons. We performed a meta-analysis of comparative studies using both approaches to highlight differences in outcomes for primary benign cardiac tumour surgery.
Methods.
A literature search was performed using PubMed, EMBASE and Google Scholar until January 2023. 12 publications were analysed, including a total of 877 patients. 359 (40.9%) had a minimally invasive (MT) approach compared to 518 patients (59.1%) who had a median sternotomy (MS) approach during primary benign cardiac tumour surgery. The outcomes analysed include mortality, post-operative stroke, renal failure, atrial fibrillation (AF), length of hospital stay, reoperation for bleeding, wound infection, cardiopulmonary bypass (CPB) times, cross-clamp times, transfusion of red blood cells (RBC), intubation, chest drainage, and Intensive Therapy Unit (ITU) stay. Revman 5.4.1 (Cochrane Revman, UK, September 2020) was used to perform the statistical analysis. Weighted mean differences (WMD) were calculated for the effect size of continuous variables. Pooled odds-ratios (OR) were calculated for discrete variables. Random effects model with a 95% confidence interval (CI) was used and P < 0.05 was considered statistically significant.
Results.
There was a significantly reduced length of hospital stay (Std Mean Difference =-1.00, p = 0.0004), ITU stay (Std Mean Difference = -0.83, p = 0.01), RBC transfusion (Pooled OR = +0.32, p< 0.00001), chest tube drainage (Std Mean difference = -1.24, p < 0.00001) and post-operative AF (Pooled OR = +0.56, p = 0.04) with the minimally invasive approach. But there was increased CPB (Std Mean Difference = +0.79, p < 0.00001) and cross-clamp time (Std Mean Difference = +0.42, p = 0.001), when compared with median sternotomy. No significant difference was observed in mortality (Pooled OR = +0.35, p = 0.36) or incidence of post-operative stroke (Pooled OR = +0.62, p = 0.73). No significant differences observed for re-operation for bleeding, wound infection rates, renal failure and ventilation times
Conclusion.
Surgical resection of primary benign cardiac tumours via a minimally invasive approach is a safe and effective method with comparable outcomes. ICU stay, post-operative length of hospital stay, chest tube drainage, the need for reduced transfusion requirements and the lower incidence of atrial fibrillation are potential benefits with this approach. More extensive studies including RCTs are needed to confirm the benefits of a minimally invasive approach
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