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Minithoracotomy Versus Ministernotomy For Minimally Invasive Aortic Valve Replacement: An Updated Meta-analysis Of Comparative Studies
Kristine Santos1, Kensei Oya
2, Victoria Zecchin Ferrara
3, Melissa Chacón Quirós
4, Samaniego Laguna Miguel Angel
5, Victor Lopez Barrios
6.
1NVU, Tbilisi, Georgia,
2National Center for Global Health and Medicine, Tokyo, Japan, Tokyo, Japan,
3University of Padova, Padova , Italy, Padova, Italy,
4Universidad de Costa Rica, San José, Costa Rica, San José, Costa Rica,
5Universidad Autónoma Metropolitana, Ciudad de México, Mexico, Ciudad de México, Mexico,
6Centro Cardiovascular SM, San Jose, Costa Rica, San Jose, Costa Rica.
Background: Minithoracotomy (MT) and ministernotomy (MS) are established approaches for minimally invasive aortic valve replacement (miAVR). While a previous meta-analysis of eight comparative studies failed to uncover any significant differences, the emergence of new research warrants a comprehensive re-evaluation to conclusively elucidate the relative merits of these surgical techniques, which continue to be a subject of ongoing debate.
Methods: A literature search was conducted in MEDLINE, Scopus, and Cochrane Library, focusing on studies that compared MT and MS for miAVR. RevMan 8.13.0 was used to calculate effect estimates reported as odds ratios (OR) and mean differences (MD), with 95% confidence intervals (CI).
Results: The meta-analysis included 22 studies encompassing 7,863 patients, with 3,689 (46.9%) cases performed via MT. The pooled results demonstrated a significant decrease in mortality [OR 0.53; 95% CI 0.36-0.78; p<0.05], blood loss [MD -20.79 mL; 95% CI -31.33 to -10.25; p<0.05], and blood transfusion requirements [OR 0.73; 95% CI 0.62-0.85; p<0.05] in the MT group. However, patients who underwent MT experienced longer ICU [MD 0.14 days; 95% CI 0.11-0.18; p<0.05] and hospital stay [MD 0.41 days; 95% CI 0.25-0.57; p<0.05]. Moreover, the MT approach was associated with a higher rate of conversion to sternotomy [OR 2.36; 95% CI 1.88-2.97; p<0.05] and reoperation for bleeding [OR 1.53; 95% CI 1.18-2.00; p<0.05]. Finally, other outcomes not reported in the prior meta-analysis, such as inotropic support [OR 1.58; 95% CI 1.13-2.21; p<0.05] and acute kidney injury [OR 2.33; 95% CI 1.85-2.95; p<0.05], were also significantly higher in the MT cohort.
Conclusion: This updated meta-analysis suggests that although MT may offer advantages like reduced mortality, blood loss, and blood transfusion requirements, it is associated with higher rates of conversion to sternotomy, reoperation for bleeding, and longer hospital and ICU stay compared to MS; findings not previously observed in the prior meta-analysis. The trade-offs between the two techniques should be carefully considered when selecting the optimal approach for miAVR.
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