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Amin A, Kumar R, Mokhtassi SS, Alassiri AK, Odaman A, Khan MAR, Lakshmana S, Din ZU, Acharya P, Cheema HA, Nashwan AJ, Khan AA, Hussain A, Bhudia S, Vincent RP. Minimally invasive vs. conventional mitral valve surgery: a meta-analysis of randomised controlled trials. Front Cardiovasc Med 2024; 11:1437524. [PMID: 39188318 PMCID: PMC11345173 DOI: 10.3389/fcvm.2024.1437524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/23/2024] [Indexed: 08/28/2024] Open
Abstract
Objective The evidence underlying the efficacy and safety of minimally invasive mitral valve surgery (MIMVS) is inconclusive. We conducted a meta-analysis to evaluate whether MIMVS improves clinical outcomes compared with conventional sternotomy. Methods We searched MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov from inception to January 2024 for all randomised controlled trials (RCTs), comparing MIMVS with conventional mitral valve surgery. RevMan 5.4 was used to analyse the data with risk ratio (RR) and mean difference (MD) as the effect measures. Results Eight studies reporting data on 7 RCTs were included in our review. There was no significant difference in all-cause mortality, the number of patients requiring blood product transfusion, and the change from baseline in the SF-36 physical function scores between the MIMVS and conventional sternotomy groups. MIMVS reduced the length of hospital stay (MD -2.02 days, 95% CI: -3.66, -0.39) but did not affect the length of ICU stay, re-operation for bleeding, and the incidence of renal injury, wound infection, neurological events, and postoperative moderate or severe mitral regurgitation. MIMVS was associated with a trend toward lower postoperative pain scores (MD -1.06; 95% CI: -3.96 to 0.75). Conclusions MIMVS reduced the number of days spent in the hospital and showed a trend toward lower postoperative pain scores, but it did not decrease the risk of all-cause mortality or the number of patients needing blood product transfusions. Further large-scale RCTs are required to inform definitive conclusions, particularly with regard to quality-of-life outcomes investigating functional recovery. Systematic Review Registration PROSPERO (CRD42023482122).
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Affiliation(s)
- Aamir Amin
- Department of Cardiothoracic Surgery, Harefield Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rajanikant Kumar
- Department of Cardiothoracic and Vascular Surgery, Jay Prabha Medanta Super Specialty Hospital, Patna, India
| | - Shiva Seyed Mokhtassi
- Department of Cardiothoracic Surgery, Harefield Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Agatha Odaman
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Shashi Lakshmana
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Zahir Ud Din
- Department of Surgery, Khyber Medical College, Peshawar, Pakistan
| | | | | | | | - Arsalan Ali Khan
- Department of Cardiothoracic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Awab Hussain
- Department of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Sunil Bhudia
- Department of Cardiothoracic Surgery, Harefield Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Royce P. Vincent
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Brega C, Raviola E, Zucchetta F, Tripodi A, Albertini A. Periareolar approach in female patients undergoing mitral and tricuspid valve surgery: An almost invisible surgical access. J Card Surg 2022; 37:2581-2585. [PMID: 35726656 DOI: 10.1111/jocs.16693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Periareolar minithoracotomy represents an interesting option in minimally invasive cardiac surgery and it is our preferred approach for women. Our aim is to assess the results in female patients, in terms of nipple postoperative pain, local sensitivity, and eventual alterations in mammography after surgery. METHODS Fifty-seven female patients underwent periareolar incision, as minithoracotomy approach, from December 2018 to December 2021. Their mean age was 56 ± 12 years, their body mass index was 22.5 ± 4.8; their surgery was elective in 93%, with mean Euroscore II about 2 ± 1.3. RESULTS Of 57 patients, 87.7% (50 patients) underwent mitral valve repair, whose six with associated procedures; 8.8% (five patients) underwent mitral valve replacement whose two with tricuspid annuloplasty associated and 3.5% (two patients) had isolated tricuspid surgery. The cardiopulmonary bypass and aortic cross-clamp time were 123.2 ± 30.2 and 101.3 ± min respectively. There were no conversions to either full sternotomy or larger thoracotomy approach. There were no in-hospital and follow-up deaths. No strokes or wound infections were observed. Mean follow-up was 16± 9 months. Within the investigated follow-up, 100% of the patients were satisfied with the esthetic result, no remarkable postoperative pain was reported, two patients had slight hyposensitivity in the nipple area. About 50% IThad mammography as prevention screening after surgery and no abnormalities were found. CONCLUSIONS Periareolar minithoracotomy is a feasible surgical option in female patients, with excellent healing and cosmetic results and preserving the tissues of the mammary gland.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Eliana Raviola
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Fabio Zucchetta
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Alberto Tripodi
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Alberto Albertini
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
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Hage A, Hage F, Al-Amodi H, Gupta S, Papatheodorou SI, Hawkins R, Ailawadi G, Mittleman MA, Chu MWA. Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A Systematic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:310-316. [PMID: 33781118 PMCID: PMC8414825 DOI: 10.1177/15569845211000332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The safety of minimally invasive mitral valve surgery (MIMVS) in elderly
patients is still debated. Our objective was to perform a systematic review
and meta-analysis of studies comparing MIMVS with conventional sternotomy
(CS) in elderly patients (≥65 years old). Methods We searched PubMed, EMBASE, Web of Science, clinicaltrials.gov, and Cochrane
Central Register of Controlled Trials for trials and observational studies
comparing MIMVS with CS in patients ≥65 years old presenting for mitral
valve surgery. We performed a random-effects meta-analysis of all
outcomes. Results The MIMVS group had lower odds of acute renal failure (odds ratio [OR] 0.27;
95% CI 0.10 to 0.78), prolonged intubation (>48 h; OR 0.47; 95% CI 0.31
to 0.70), less blood product transfusion (weighted mean difference [WMD]
−0.82 units; 95% CI −1.29 to −0.34 units), shorter ICU length of stay (LOS;
WMD −2.57 days; 95% CI −3.24 to −1.90 days) and hospital LOS (WMD −4.06
days; 95% CI −5.19 to −2.94 days). There were no significant differences in
the odds of mortality, stroke, respiratory infection, reoperation for
bleeding, and postoperative atrial fibrillation. MIMVS was associated with
longer cross-clamp (WMD 11.8 min; 95% CI 3.5 to 20.1 min) and
cardiopulmonary bypass times (WMD 23.0 min; 95% CI 10.4 to 35.6 min). Conclusions MIMVS in elderly patients is associated with lower postoperative
complications, blood transfusion, shorter ICU, and hospital LOS, and longer
cross-clamp and bypass times.
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Affiliation(s)
- Ali Hage
- 622170384 Western University, London, ON, Canada.,1857 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fadi Hage
- 622170384 Western University, London, ON, Canada.,1857 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Suruchi Gupta
- 1857 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Robert Hawkins
- 235821614 University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- 235821614 University of Virginia, Charlottesville, VA, USA
| | - Murray A Mittleman
- 1857 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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