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Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A Meta-Analysis.
Chang, Carolyn; Raza, Sajjad; Altarabsheh, Salah E; Delozier, Sarah; Sharma, Umesh M; Zia, Aisha; Khan, Muhammad Shahzeb; Neudecker, Mandy; Markowitz, Alan H; Sabik, Joseph F; Deo, Salil V.
Afiliación
  • Chang C; School of Medicine, Case Western Reserve University, Cleveland, Ohio.
  • Raza S; Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
  • Altarabsheh SE; Department of Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan.
  • Delozier S; Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
  • Sharma UM; Community Division of Hospital Medicine, Mayo Clinic Health System, Rochester, Minnesota.
  • Zia A; Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Khan MS; Division of Internal Medicine, Cook County Hospitals, Chicago, Illinois.
  • Neudecker M; Medical Librarian, Core Library, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
  • Markowitz AH; Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
  • Sabik JF; Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
  • Deo SV; Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Electronic address: svd14@case.edu.
Ann Thorac Surg ; 106(6): 1881-1889, 2018 12.
Article en En | MEDLINE | ID: mdl-30189193
BACKGROUND: Limited data exist studying the outcomes of the 2 minimally invasive aortic valve replacement (AVR) strategies-mini-sternotomy (AVR-st) and right anterior thoracotomy (AVR-th). We conducted an indirect meta-analysis to compare the outcomes of these minimally invasive approaches with each other and with conventional AVR (cAVR). METHODS: We Searched Medline, PubMed, Embase, and Web of Science in December 2017 for studies comparing AVR-st, AVR-th, and cAVR. Clinical outcomes were compared between cohorts with inverse weighted random effects modeling. Endpoints studied included hospital mortality, stroke, atrial fibrillation, cardiopulmonary bypass (CPB) time, and length of stay. RESULTS: A total of 19 studies (>10,000 pooled patients) met the inclusion criteria. Mortality (p = 0.06) and stroke (p = 0.15) were comparable between minimally invasive and conventional AVR. CPB times were longer with AVR-th versus cAVR (12.4 minutes [range, 5 to 19]; p < 0.01). In the AVR-th cohort, CPB duration was weakly inversely related to study size (p = 0.06). Atrial fibrillation was much less after AVR-th (odds ratio 0.47 [0.35 to 0.63]; p < 0.001). Hospital stay was significantly lower after minimally invasive surgery (0.8 [0.4 to 1.3] days; p < 0.01). AVR-th patients were dismissed 2.1 (1.6 to 2.7) days earlier than cAVR patients. CONCLUSIONS: Minimally invasive approaches to AVR yield excellent outcomes in high-volume centers. They reduce hospital stay and incidence of postoperative atrial fibrillation, and therefore should be considered in patients undergoing AVR. The operative approach should be selected according to surgeon's technical expertise and what is best for specific patient profile, however.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Válvula Aórtica / Implantación de Prótesis de Válvulas Cardíacas Tipo de estudio: Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Ann Thorac Surg Año: 2018 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Válvula Aórtica / Implantación de Prótesis de Válvulas Cardíacas Tipo de estudio: Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Ann Thorac Surg Año: 2018 Tipo del documento: Article Pais de publicación: Países Bajos