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The Journal of Cardiovascular Surgery 2021 Oct 19

DOI: 10.23736/S0021-9509.21.11902-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Conventional sternotomy versus right mini-thoracotomy versus robotic approach for mitral valve replacement/repair; insights from a network meta-analysis

Yujiro YOKOYAMA 1, Toshiki KUNO 2, 3 , Hisato TAKAGI 4, Alexandros BRIASOULIS 5, Takeyoshi OTA 6

1 Department of Surgery, St. Luke’s University Health Network, Bethlehem, PA, USA; 2 Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA; 3 Department of Cardiology, Montefiore Medical Center/Albert Einstein Medical College, New York, NY, USA; 4 Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; 5 Division of Cardiovascular medicine, Section of Heart failure and Transplantation, University of Iowa, Iowa City, IA, USA; 6 Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA



OBJECTIVE: Minimally invasive cardiac surgery (MICS) through right mini-thoracotomy as well as robotic surgery has emerged for the last decade for mitral valve surgery. However, their risks and benefits are not fully understood yet. Thus, we conducted a network meta-analysis comparing the early- and long-term outcomes of mitral valve surgery via the conventional sternotomy, MICS, and robotic approaches.
EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through November, 2020 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) trials that investigated early- and long-term outcomes after mitral surgery via the conventional sternotomy, MICS, and robotic approaches. A subalalysis focusing on only subjects who initially underwent mitral valve repair was also conducted.
EVIDENCE SYNTHESIS: Our systematic literature search identified 2 RCTs and 19 PSM studies. MICS was related to significant risk reductions of permanent pacemaker implantation, surgical site infection, and transfusion compared to the sternotomy approach. The robotic approach was associated with a significant increase in re-exploration for bleeding compared to sternotomy. The subanalysis showed that MICS was associated with a significant increase requiring mitral valve reoperation compared to the sternotomy approach (hazard ratio [95% confidence interval] =7.33 [1.54-34.97], p=0.012), while no significant difference was observed between the sternotomy and the robotic approach.
CONCLUSIONS: Our network meta-analysis demonstrated that MICS was associated with better short-term outcomes compared to the sternotomy approach. Mitral valve reoperation was more frequent with MICS compared with the sternotomy approach after mitral valve repair, while no difference was observed between the sternotomy and robotic approaches.


KEY WORDS: Mitral valve replacement; Mitral valve repair; Robotic surgery; Minimally invasive surgery; MICS

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