No abstract

Background Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta‐analysis aims to compare operative and peri‐operative outcomes of MIS vs MS in MVD. Methods PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra‐ and postoperative times, reoperation for bleeding and surgical site infection were evaluated. Results Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle‐Ottawa scale was good for all included studies. Meta‐analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365‐0.608; P < .0001). Similarly, aortic cross‐clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509‐0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay. Conclusions MIS for MVD have similar short‐term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.

No abstract

Background: Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. Methods: PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). Results: Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04–5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20–1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05–1.54, I2 = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04–0.80, I2 = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69–21.63 in favour of MIS, I2 = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23–10.91, I2 = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19–1.04, I2 = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09–1.59, I2 = 0.0%). Conclusions: MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings.