血管学: オープンアクセス
オープンアクセス

概要

Comparing Conventional and Minimally Invasive Sternotomy for Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Theodoros Mavridis*

Aim: We aimed to compare the safety and outcomes of the minimally invasive approaches versus conventional sternotomy procedure for aortic valve replacement.

Methods: We conducted a PRISMA-compliant systematic review and meta-analysis. We ran an electronic search of PubMed, Cochrane CENTRAL, Scopus, and Web of Science to identify the relevant published studies. Data were extracted and pooled in the DerSimonian Liard meta-analysis model as Standardized Mean Difference (SMD) or Risk Ratio (RR) using StataMP version 17 for macOS.

Results: Forty-one studies with a total of 15,065 patients were included in this meta-analysis (minimally invasive approaches n=7231 vs. conventional sternotomy n=7834). The pooled effect size showed that minimally invasive approaches had lower mortality rates [RR 0.76, 95%CI (0.59 to 0.99)], intensive care unit and hospital stays (SMD -0.16 and -0.31, respectively), ventilation time [SMD -0.26, 95%CI (-0.38 to -0.15)], 24 h chest tube drainage [SMD -1.03, 95%CI (-1.53 to -0.53)], RBCs transfusion [RR 0.81, 95%CI (0.70 to 0.93)], wound infection [RR 0.66, 95%CI (0.47 to 0.92)] and acute renal failure [RR 0.65, 95%CI (0.46 to 0.93)] However, minimally invasive approaches had longer operative time, cross-clamp, and bypass times [SMD 0.47, 95%CI (0.22 to 0.72), SMD 0.27, 95%CI (0.07 to 0.48), and SMD 0.37, 95%CI (0.20 to 0.45)], respectively. There were no differences between the two groups in blood loss, endocarditis, cardiac tamponade, stroke, arrhythmias, pneumonia, pneumothorax, bleeding reoperation, tracheostomy, hemodialysis, or myocardial infarction, (all p>0.05).

Conclusion: Current studies have proved that minimally invasive aortic valve replacement has less mortality and better post-operative outcomes compared to the conventional approach. Future RCTs with long-term follow-ups are recommended.