Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy

Miceli, Antonio; Murzi, Michele; Gilmanov, Daniyar; Fugà, Raffaele; Ferrarini, Matteo; Solinas, Marco; Glauber, Mattia

doi:10.1016/j.jtcvs.2013.07.060

Cited by 121 publications

(127 citation statements)

References 19 publications

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“…In the only direct comparative study, Miceli et al (27) investigated 251 MT and 155 MS patients and concluded that MT was associated with lower postoperative atrial fibrillation and shorter hospitalization. In contrast, subgroup analysis of a recent meta-analysis (2) suggested that MS may be associated with superior mortality outcomes compared to MT patients.…”

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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“…Miceli established a higher survival rate at 1 and 5 years and a lower incidence of postoperative atrial fibrillation, shorter ventilation time, decreased ICU and hospital length of stay in the minithoracotomy group as compared to the ministernotomy group (15). These differences demonstrate the need for future studies to separate and distinguish the approaches, in order to more accurately measure and compare miniAVR outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…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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“…[1][2][3][4][5][6][7][8][9][10] The technique utilized in our unit, i.e. J-sternotomy is also known as an upper hemisternotomy and is a routinely performed minimally invasive AVR technique in many centers.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The more frequent use of sutureless valves along with growing expertise may be expected to result in the more frequent use of minimally invasive approaches for AVR. [8,9] Clinically, surgery performed using smaller incisions offer a number of advantages such as reduced postoperative pain and surgical trauma. [3][4][5] Also, a minimally invasive AVR appears to be superior to aortic valve surgery with a conventional sternotomy in terms of less bleeding, shorter ventilation and a reduced length of time in the intensive care unit and a shorter hospital stay.…”

mentioning

confidence: 99%

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Erkanlı¹

2016

Cardiovasc Surg Int

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Objectives: This study aims to present our single-center experience of an aortic valve replacement using a minimally invasive J-sternotomy incision and to compare the early clinical outcomes of these procedures with a median sternotomy. Patients and methods:Between January 2014 and May 2015, 38 patients underwent isolated aortic valve replacement operations using a minimally invasive or a conventional sternotomy. A J-sternotomy (group JS) incision was used on 18 patients (12 males, 6 females; mean age 57.0±17.9 years; range 19 to 62 years), whereas a median sternotomy (group MS) incision was performed on 20 patients (13 males, 7 females; mean age 57.4±16.3 years; range 22 to 65 years). Preoperative characteristics, perioperative data and early outcomes were compared. Patient selection techniques, the surgical approach and our experience during the procedures were presented. Results:No mortality developed. The types (p=0.36) and dimensions (p=0.99) of implanted aortic valves were similar between the groups. There was no significant difference between the JS and MS groups in terms of cross-clamp (68.4±30.1 vs. 64.7±29.9 minutes, p=0.70) and cardiopulmonary bypass time (112.3±43.1 vs. 94.8±43.8 minutes, p=0.22). In the group JS, conversion to full sternotomy was needed in one patient due to poor surgical exposure. The lengths of intensive care unit [1.7±1.7 vs 2.2±1.2 days, (p=0.33)] and hospital [7.1±2.7 vs 7.2±1.2 days, (p=0.66)] stays were similar between the groups. A mediastinal exploration due to bleeding was performed using a full sternotomy in two patients (11.2%) from group JS. There was no significant difference in postoperative complications. Conclusion:Since it is minimally invasive for aortic valve replacement using a J-sternotomy incision is a safe and reproducible procedure. The use of a minimally invasive aortic valve replacement technique does not lead to a higher incidence of postoperative complications and associated mortality.

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Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy

Abstract: Minimally invasive AVR using RT was associated with lower postoperative morbidities and a shorter hospital stay than MS.

Cited by 121 publications

References 19 publications

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

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

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

J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

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