Is ministernotomy superior to right anterior minithoracotomy in minimally invasive aortic valve replacement?

Abstract

A best evidence topic was constructed according to a structured protocol. The question addressed was whether, in patients undergoing minimally invasive aortic valve replacement (AVR), right anterior thoracotomy (RT) or mini-sternotomy (MS) was superior in terms of postoperative outcome? A total of 840 publications were found using the reported search. Of these, 6 represented the best available evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In all, except 1 study, the primary outcome was early mortality, ranging from in-hospital mortality to 90 days postoperatively. The remaining study was a cost-benefit analysis. Four studies were non-randomized observational studies, one of which was multicentre. Two were meta-analyses of studies comparing minithoracotomy or MS with conventional sternotomy for AVR, rather than direct comparisons of the 2 minimal access techniques. We conclude that there is a lack of high-quality evidence comparing RT and MS for minimally invasive AVR, with no randomized controlled trials to date. The available evidence shows no difference in early mortality between RT and MS for surgical AVR. In studies that directly compared RT and MS, RT was found to be associated with reduced length of hospital stay, despite longer cardiopulmonary bypass times and cross-clamp times. One study reported groin complications (10.8%) with the RT group, where peripheral cannulation was used, while the other 5 studies did not comment on groin complications associated with peripheral cannulation. In the only cost-benefit analysis, RT was found to carry considerably more cost than MS over and above conventional AVR.

Right thoracotomy for aortic valve replacement in the adolescents with bicuspid aortic valve

“…In the only cost-benefit analysis, RAMT was found to carry considerably more cost than MS over and above conventional AVR. 13 In our experience, our skin incision was slightly greater than other authors but all patients received the CPB implantation totally through the thoracotomy, avoiding the complications of peripheral cannulation (Figure 1). RAMT did not influence the implantation A very important aspect for this surgery is the psychology of patients, who are in a very special phase of life such as adolescence.…”

“…A total of 840 publications were found but only 6 represented the best available evidence to answer the clinical question. 13 In our experience, our skin incision was slightly greater than other authors but all patients received the CPB implantation totally through the thoracotomy, avoiding the complications of peripheral cannulation ( Figure 1). 13 The available evidence shows no difference in early mortality between RAMT and MS for surgical AVR.…”

“…They concluded that there was a lack of high-quality evidence comparing RAMT and MS for minimally invasive AVR, with no randomized controlled trials to date. 13 The available evidence shows no difference in early mortality between RAMT and MS for surgical AVR. Mostly, in studies that directly compared RAMT and MS, RAMT was found to be associated with reduced length of hospital stay, despite longer cardiopulmonary bypass times and cross-clamp times.…”

“…Mostly, in studies that directly compared RAMT and MS, RAMT was found to be associated with reduced length of hospital stay, despite longer cardiopulmonary bypass times and cross-clamp times. 13 One study reported groin complications (10.8%) with the RAMT group, where peripheral cannulation was used, while the other five studies did not comment on groin complications associated with peripheral cannulation. In the only cost-benefit analysis, RAMT was found to carry considerably more cost than MS over and above conventional AVR.…”

“…13 The available evidence shows no difference in early mortality between RAMT and MS for surgical AVR. A total of 840 publications were found but only 6 represented the best available evidence to answer the clinical question.…”