Minimally Invasive Reoperative Isolated Valve Surgery: Early and Mid-Term Results

Abstract

Reoperative valve surgery can be safely performed using a nonsternotomy, minimally invasive approach, with at least equal mortality, less hospital morbidity, decreased hospital length of stay, and slightly favorable mid-term survival as compared to sternotomy.

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

“…Our search revealed seven studies [8][9][10][11][12][13][14] fulfilling these inclusion criteria, producing a pooled data set of 1,254 patients of whom 731 underwent ST and 523 underwent MIMVS (Table 2). There was 100% concordance between reviewers, equating to a Cohen's kappa coefficient of 1.…”

“…There was 100% concordance between reviewers, equating to a Cohen's kappa coefficient of 1. Five studies were retrospective observational in design [8,10,[12][13][14], and two were propensity-matched studies ST ¼ sternotomy. [9,11].…”

“…Two studies, although observational, included two very homogeneous populations [8,10]. One study reported an amalgamated secondary outcome for minimally invasive mitral and aortic valve surgery; thus, relevant data could not be retrieved [12]. Another study reported amalgamated outcomes for both primary (mortality) and secondary outcomes for minimally invasive mitral and aortic valve surgery, so it was subsequently excluded from our quantitative analysis to avoid any contamination of the experimental group and reduce clinical heterogeneity [15].…”

“…Mihos and colleagues [8] included infective endocarditis and chronic obstructive pulmonary disease (40.9%) and redo operations (18.1%); Tang and associates [9] included patients with chronic renal failure and New York Heart Association functional class IV (43%), redo operations (37.7%), infective endocarditis (17.7%), and chronic obstructive pulmonary disease (22.2%); Iribarne and coworkers [10] included patients older than 75 years and those with chronic obstructive pulmonary disease (18.5%); Holzhey and colleagues [11] included patients older than 70 years and those with redo operations (14.7%), chronic obstructive pulmonary disease (8.6%), infective endocarditis (4.9%), and left ventricular ejection fraction of less than 30% (4.9%); and Sharony and associates [12], Bolotin and coworkers [13], and Burfeind and colleagues [14] included specifically redo patients (Table 2). Combined procedures (tricuspid valve) were also included in the studies by Tang and coworkers [9], Holzhey and colleagues [11], and Sharony and associates [12]. Moreover, the modified NewcastleOttawa scale based on 17 EuroSCORE II risk factors was used to both check comparability and numbers of risk factors included.…”

“…Moreover, a transthoracic aortic clamp was preferred over an intraaortic balloon clamp in all four series. In studies that included mainly redo operation patients [12][13][14], both ventricular fibrillation arrest and endoclamping were used, although direct clamping was reported in some cases in one series [12]. As in other reports [1,19], CPB time was significantly longer in the MIMVS group, but heterogeneity was evident as expected for continuous parameters.…”