Minimal Access Aortic Valve Replacement: Is It Worth It?

Murtuza, Bari; Pepper, John; Stanbridge, Rex; Jones, Catherine; Rao, Christopher; Darzi, Ara; Athanasiou, Thanos

doi:10.1016/j.athoracsur.2007.09.038

Cited by 183 publications

(165 citation statements)

References 39 publications

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“…The incisions range from 4 to 8 cm and can be hidden in the submammary groove, while those of conventional MS are much longer and more unsightly. Murtuza et al (2008) found that 282 of 308 patients (91.5%) were satisfied with the cosmetic result of ALMT. Three studies found that ALMT resulted in less pain and a higher quality of life in patients with mitral valve disease after operation (Walther et al, 1999;Felger Iribarne et al (2010) New York 91.9 (at 4 years) 91.9 (at 4 years) 0.569 Holzhey et al (2011) Leipzig 66±5.6 (at 5 years) 56±5.5 (at 5 years) 0.43 Speziale et al (2011) Bari 67 (at 2 years) 69 (at 2 years) 0.86 66 (at 2 years) 67 (at 2 years) 0.74 Reser et al (2012) Zürich 100 (at 1.8 years) 97.8 (at 1.8 years)…”

Section: Discussionmentioning

confidence: 99%

“…Ding et al (2012) evaluated ALMT in congenital heart disease and suggested that this had a longer CPB time and ACCT, but shorter intubation time, ICU time, and LOHS. The remaining three studies compared a minimally invasive procedure with conventional sternotomy for aortic valve replacement (Murtuza et al, 2008;Brown et al, 2009;Khoshbin et al, 2011) and included RCTs and non-randomized studies. They concluded that a mini-sternotomy can be performed safely for aortic valve replacement without an increased risk of death, major complications (Khoshbin et al, 2011), a reduction in ICU stay time (Brown et al, 2009), or clinical benefit (Aybek et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

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Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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“…In spite of that, randomized controlled trails as well as meta-analysis studies (Aris et al, 1999;J. M. Brown et al, 2009;Dogan et al, 2003;Murtuza et al, 2008) were not able to show a convincing superiority of MIAVR over CAVR.…”

Section: Conventional Aortic Valve Replacement (Cavr) Through Full Stmentioning

confidence: 99%

“…In spite of that, randomized controlled trails as well as meta-analysis studies (Aris et al, 1999;J. M. Brown et al, 2009;Dogan et al, 2003;Murtuza et al, 2008), were not able to show a convincing superiority of MIAVR over CAVR Aim: This study aimed to determine whether the MIAVR via upper partial sternotomy offers significant advantages in the postoperative outcomes (morbidities and mortalities) over CAVR via standard full sternotomy.…”

Section: Summary Of the Studymentioning

confidence: 99%

015 * Propensity Score Analysis of Outcomes Following Minimally Invasive Versus Conventional Aortic Valve Replacement

Shehada

Voß

Elhmidi

et al. 2014

Interactive CardioVascular and Thoracic Surgery

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“…This reduces the incision from an average of 24.5 to 7.17 cm with a ministernotomy, or a 5 cm incision with a thoracotomy (13,14). MiniAVR has been shown to: reduce length of intensive care unit (ICU) and hospital stay, reduce ventilation time, decrease the need for blood transfusion, decrease pain, and improve the cosmetic result (15)(16)(17). A Cochrane review that included seven randomized controlled trials compared AVR via median sternotomy vs. were comparable between the minithoracotomy and ministernotomy groups, respectively (20).…”

Section: Miniavrmentioning

confidence: 99%

Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

Hoffmann

Heiner

Nguyen

2017

Ann. Cardiothorac. Surg.

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Transcatheter aortic valve replacement (TAVR) and minimally invasive aortic valve replacement (miniAVR) have become alternatives to surgical aortic valve replacement via median sternotomy (SAVR) to treat severe aortic stenosis (AS). Despite increased interest and utilization, few studies have directly compared TAVR and miniAVR. A review of the current literature shows TAVR to be an indispensable tool for inoperable, high-risk, and perhaps intermediate-risk patients with severe AS. However, it is associated with a number of deleterious perioperative outcomes, such as valvular regurgitation and vascular complications. MiniAVR is associated with decreased intensive care unit (ICU) and hospital length of stay, a lower incidence of blood transfusions, decreased ventilation time, and improved cosmetic results. MiniAVR maintains potential advantages over SAVR, including the implantation of a durable prosthesis and low rates of perioperative myocardial infarction and paravalvular leak. It is associated with longer aortic cross clamp and cardiopulmonary bypass (CPB) times; however, the use of sutureless valve implants can circumvent this. Studies comparing TAVR and miniAVR demonstrate decreased postoperative mortality, valvular regurgitation, and incidence of stroke in the miniAVR cohorts. Few studies currently exist comparing TAVR and miniAVR, as it is hard to compare the typically low-risk miniAVR versus high-risk TAVR patient populations. It is clear that both strategies will be cornerstones in the modern AVR era, but the situations in which to apply each strategy have not yet been clearly delineated. This highlights the need for surgeons to adopt these minimally invasive techniques. We believe there is a compelling role for miniAVR in low-and intermediate-risk patients, but due to the paucity of data, neither TAVR nor miniAVR should be discounted before a randomized, risk-stratified trial is performed. More studies are needed to compare TAVR and miniAVR in low-and intermediate-risk patients.

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Minimal Access Aortic Valve Replacement: Is It Worth It?

Cited by 183 publications

References 39 publications

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

015 * Propensity Score Analysis of Outcomes Following Minimally Invasive Versus Conventional Aortic Valve Replacement

Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

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