Minimally invasive versus conventional aortic valve replacement: The network meta-analysis.
aortic valve replacement
mini-sternotomy
thoracotomy
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
07
10
2022
accepted:
27
10
2022
pubmed:
16
11
2022
medline:
6
1
2023
entrez:
15
11
2022
Statut:
ppublish
Résumé
Outcome comparisons after surgical aortic valve replacement (SAVR) with minimally invasive approaches including mini-sternotomy (MS) and right mini-thoracotomy (RMT) and full sternotomy (FS) have been conflicting. Furthermore, the synthesis of mid-term mortality has not been performed. MEDLINE and EMBASE were searched through April 2022 to identify propensity score matched (PSM) studies or randomized controlled trial (RCT) which compared outcomes following SAVR among three incisional approaches: FS, MS, or RMT. The network analysis was performed to compare these approaches with random effects model. Mid-term mortality was defined as 1-year mortality. A total of 42 studies met the inclusion criteria enrolling 14,925 patients. RCT and PSM were performed in 13 and 29 studies, respectively. The operative mortality was significantly lower with MS compared to FS (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.41-0.90, p = .01, I While mid-term mortality was comparable among approaches, MS may be a safe and potentially more effective approach than FS and RMT for SAVR in the short term.
Sections du résumé
BACKGROUND
BACKGROUND
Outcome comparisons after surgical aortic valve replacement (SAVR) with minimally invasive approaches including mini-sternotomy (MS) and right mini-thoracotomy (RMT) and full sternotomy (FS) have been conflicting. Furthermore, the synthesis of mid-term mortality has not been performed.
METHODS
METHODS
MEDLINE and EMBASE were searched through April 2022 to identify propensity score matched (PSM) studies or randomized controlled trial (RCT) which compared outcomes following SAVR among three incisional approaches: FS, MS, or RMT. The network analysis was performed to compare these approaches with random effects model. Mid-term mortality was defined as 1-year mortality.
RESULTS
RESULTS
A total of 42 studies met the inclusion criteria enrolling 14,925 patients. RCT and PSM were performed in 13 and 29 studies, respectively. The operative mortality was significantly lower with MS compared to FS (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.41-0.90, p = .01, I
CONCLUSIONS
CONCLUSIONS
While mid-term mortality was comparable among approaches, MS may be a safe and potentially more effective approach than FS and RMT for SAVR in the short term.
Types de publication
Meta-Analysis
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4868-4874Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Carroll JD, Mack MJ, Vemulapalli S, et al. STS-ACC TVT registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;76:2492-2516.
Oo S, Khan A, Chan J, et al. Propensity matched analysis of minimally invasive versus conventional isolated aortic valve replacement. Perfusion. Published online September 13, 2021. 026765912110458. doi:10.1177/02676591211045802
Seitz M, Goldblatt J, Paul E, Marcus T, Larobina M, Yap CH. Minimally invasive aortic valve replacement via right anterior mini-thoracotomy: propensity matched initial experience. Heart, Lung Circ. 2019;28:320-326.
Rodríguez-Caulo EA, Guijarro-Contreras A, Guzón A, et al. Quality of life after ministernotomy versus full sternotomy aortic valve replacement. Semin Thorac Cardiovasc Surg. 2021;33:328-334.
D'Onofrio A, Tessari C, Lorenzoni G, et al. Minimally invasive vs conventional aortic valve replacement with rapid-deployment bioprostheses. Ann Thorac Surg. 2021;111:1916-1922.
Hancock HC, Maier RH, Kasim A, et al. Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial. BMJ Open. 2021;11:e041398. doi:10.1136/bmjopen-2020-041398
Vukovic PM, Milojevic P, Stojanovic I, et al. The role of ministernotomy in aortic valve surgery-a prospective randomized study. J Card Surg. 2019;34:435-439.
Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: a meta-analysis. Ann Thorac Surg. 2018;106:1881-1889.
Yousuf Salmasi M, Hamilton H, Rahman I, et al. Mini-sternotomy vs right anterior thoracotomy for aortic valve replacement. J Card Surg. 2020;35:1570-1582.
Rodriguez E, Malaisrie SC, Mehall JR, et al. Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: a multi-institution analysis of ‘real world’ data. J Med Econ. 2014;17:846-852.
Gofus J, Vobornik M, Koblizek V, et al. Pulmonary function and quality of life after aortic valve replacement through ministernotomy: a prospective randomized study. Kardiol Pol. 2020;78:1278-1280.
Nair SK, Sudarshan CD, Thorpe BS, et al. Mini-stern trial: a randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement. J Thorac Cardiovasc Surg. 2018;156:2124-2132.e31.
Meyer A, Kampen A, Kiefer P, et al. Minithoracotomy versus full sternotomy for isolated aortic valve replacement: propensity matched data from two centers. J Card Surg. 2021;36(1):97-104.
Andreas M, Berretta P, Solinas M, et al. Minimally invasive access type related to outcomes of sutureless and rapid deployment valves. Eur J Cardiothorac Surg. 2020;58:1063-1071.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89.
Deeks JJ, Higgins JPT, Altman DG, et al.(editors). Chapter 10: Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane; 2022.
Higgins JPT, Li T, Deeks JJ, et al.(editors). Chapter 6: Choosing effect measures and computing estimates of effect. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane; 2022.
Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.
Bonacchi M, Dokollari A, Parise O, et al. Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery. J Thorac Cardiovasc Surg. Published online April 23, 2021. doi:10.1016/j.jtcvs.2021.03.125
Stoliński J, Plicner D, Grudzień G, et al. A comparison of minimally invasive and standard aortic valve replacement. J Thorac Cardiovasc Surg. 2016;152:1030-1039.
Thourani VH, Forcillo J, Szeto WY, et al. Outcomes in 937 intermediate-risk patients undergoing surgical aortic valve replacement in PARTNER-2A. Ann Thorac Surg. 2018;105:1322-1329.
Rodriguez-Gabella T, Voisine P, Dagenais F, et al. Long-term outcomes following surgical aortic bioprosthesis implantation. J Am Coll Cardiol. 2018;71:1401-1412.
Perrotti A, Francica A, Monaco F, et al. Postoperative quality of life after full-sternotomy and ministernotomy aortic valve replacement. Ann Thorac Surg. Published online December 28, 2021; S0003497521021433. doi:10.1016/j.athoracsur.2021.11.055