Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients

Murzi, Michele; Cerillo, Alfredo Giuseppe; Miceli, Antonio; Bevilacqua, Stefano; Kallushi, Enkel; Farneti, Pier Andrea; Solinas, Marco; Glauber, Mattia

doi:10.1093/ejcts/ezt043

Cited by 106 publications

(89 citation statements)

References 13 publications

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“…These results were also consistent with Bayesian network meta-analysis, suggesting that both MS and MT approaches are safe, efficacious and comparable. There have been some previous concerns that the standard MT approach requires retrograde arterial perfusion through the femoral artery, which has been associated with increased risk of stroke (29,30 Total events Heterogeneity: Tau² = 0.00; Chi² = 6.64, df = 9 (P = 0.67); I² = 0% Test for overall effect: Z = 0.30 (P = 0.76)…”

Section: Discussionmentioning

confidence: 99%

Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement? A Bayesian network meta-analysis

Phan

Xie

Tsai

et al. 2015

Heart, Lung and Circulation

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Background: Establishing the relative merits of ministernotomy (MS) and minithoracotomy (MT) approaches to minimally invasive aortic valve replacement (MIAVR) is difficult given the limited available direct evidence. Network meta-analysis is a Bayesian approach that can combine direct and indirect evidence to better define the benefits and risks of MS and MT.Methods: Electronic searches were performed using six databases from their inception to June 2014.Relevant studies utilizing a minimally invasive approach for aortic valve replacement were identified. Data were extracted and analyzed according to predefined clinical endpoints. Both traditional and Bayesian metaanalysis approaches were conducted.Results: Compared to full sternotomy, MT was associated with longer cardiopulmonary bypass (CPB) duration (WMD, 9.99; 95% CI, 3.91, 16.07; I 2 =55%; P=0.001) and cross-clamp duration (WMD, 7.64; 95% CI, 2.86, 12.42; P=0.002; I 2 =74%). When compared to MS using network meta-analysis, no significant difference in duration was detected. Postoperative outcomes including 30-day mortality, stroke, and reoperation for bleeding and wound infection were comparable between MS and MT using both traditional and Bayesian meta-analysis techniques. Conclusions:The current evidence demonstrates that MIAVR via MS or MT is a safe and efficacious alternative to conventional median sternotomy. MT may be associated with longer CPB and cross-clamp durations, but has similar post-operative outcomes compared to MS. An individualized approach tailored to both the patient and surgical team is likely to provide optimal outcomes.

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Section: Discussionmentioning

confidence: 99%

Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement? A Bayesian network meta-analysis

Phan

Xie

Tsai

et al. 2015

Heart, Lung and Circulation

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“…28,29 Proposed culprits included endoaortic balloon occlusion and inadequate deairing and femoral artery cannulation. [30][31][32] On the other hand, Le Pietra et al 33 analyzed 1,501 MIVS patients and did not show this association. Until a randomized controlled trial is conducted to put this concern to rest, we are inclined towards transthoracic aortic clamping, removal of air under transesophageal echocardiographic (TEE) guidance, and recommending cannulation strategy dependent upon the surgeon's experience and comfort level.…”

Section: Performance Of Minimally Invasive Aortic Valve Surgerymentioning

confidence: 99%

Aortic Valve Surgery: Minimally Invasive Options

Ramlawi

Bedeir

Lamelas

2016

Methodist DeBakey Cardiovascular Journal

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Minimally invasive aortic valve surgery has not been adopted by a significant proportion of cardiac surgeons despite proven benefits. This may be related to a high learning curve and technical issues requiring retraining. In this review, we discuss the data for minimally invasive aortic valve surgery and describe our operative technique for both ministernotomy and anterior thoracotomy approaches. We also discuss the advent of novel sutureless valves and how these techniques compare to available transcatheter aortic valve procedures.

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“…56 One area of concern with mini-AVS and mini-MVS is the reported increased risk of cerebrovascular accidents. 57,58 In response to these concerns, LaPietra et al 59 retrospectively examined 1501 consecutive patients who underwent mini-VS at their institution over 3.5 years for evidence of cerebrovascular accidents. They observed cerebrovascular accidents in 1.53% of all cases, with over 90% receiving femoral cannulation.…”

Section: Minimally Invasive Valve Surgerymentioning

confidence: 99%