Review
Minimal Access Aortic Valve Replacement: Is It Worth It?

https://doi.org/10.1016/j.athoracsur.2007.09.038Get rights and content

Controversy surrounds the use of minimal access aortic valve replacement (AVR). This meta-analytical study quantified the effects of minimal access AVR on morbidity and mortality compared with conventional AVR and evaluated study heterogeneity and robustness of the findings using sensitivity analysis. Overall, meta-analysis suggested marginal benefits in perioperative mortality (4,667 patients; odds ratio, 0.72; 95% confidence interval, 0.51-1.00; p = 0.05), intensive care unit stay, total hospital stay, and ventilation time in the minimal access AVR group, although cross-clamp, cardiopulmonary bypass, and total operation times were longer. Study heterogeneity and apparent benefits in perioperative mortality were related to study quality, athough results for intensive care unit and hospital stay were maintained according to the sensitivity analysis. This suggests that minimal access AVR can be offered on the basis of patient choice and cosmesis rather than evident clinical benefit.

Section snippets

Literature Search

All studies of mAVR were identified from the existing literature up to July 2007. A MEDLINE literature search was performed using the Medical Subject Heading [of the US National Library of Medicine] terms “minimal,” “invasive,” “access,” and “aortic.” For the purpose of this study, “minimal access” was defined as any surgical approach other than a complete median sternotomy or full thoracotomy. A second-level search through reference lists of the included studies was performed to ensure that no

Studies Included in Meta-Analysis

We identified 89 published reports, and of these, 26 comparative studies were included in the present study: four RCTs [3, 4, 5, 6] and 22 retrospective or prospective comparative studies performed between 1998 and 2006 [1, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28]. The total number of patients in these 26 studies was 4,891, with 2,249 in the MAG and 2,642 in the conventional group (CG). Charcteristics of the included studies are shown in Table 1. Ten

Comment

The present study was performed to address two questions: (1) Can the clinical outcomes in patients undergoing AVR be improved using minimal access techniques? and (2) What is the role of mAVR in routine cardiac surgical practice? The meta-analysis performed in this study did not show any significant quantitative differences between mAVR and cAVR for perioperative mortality or other primary outcome events of CVA, renal failure, or respiratory failure. Sensitivity analysis suggested that there

References (47)

  • D. Moher et al.

    Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statementQuality of Reporting of Meta-analyses

    Lancet

    (1999)
  • A. Aris

    Reversed ”C” ministernotomy for aortic valve replacement

    Ann Thorac Surg

    (1999)
  • J.G. Byrne et al.

    Reoperative aortic valve replacement: partial upper hemisternotomy versus conventional full sternotomy

    J Thorac Cardiovasc Surg

    (1999)
  • M. Tabata et al.

    Conversion to full sternotomy during minimal-access cardiac surgery: reasons and results during a 9.5-year experience

    J Thorac Cardiovasc Surg

    (2007)
  • D.D. Glower et al.

    Predictors of outcome in a multicenter port-access valve registry

    Ann Thorac Surg

    (2000)
  • A. Cribier et al.

    Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow-up from the initial feasibility studies: the French experience

    J Am Coll Cardiol

    (2006)
  • E. Grube et al.

    Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome

    J Am Coll Cardiol

    (2007)
  • L.H. Cohn et al.

    Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair

    Ann Surg

    (1997)
  • S. Dogan et al.

    Minimally invasive versus conventional aortic valve replacement: a prospective randomized trial

    J Heart Valve Dis

    (2003)
  • H. Vanoverbeke et al.

    Operative outcome of minimal access aortic valve replacement versus standard procedure

    Acta Chir Belg

    (2004)
  • N. Doll et al.

    Minimal access aortic valve replacement: effects on morbidity and resource utilization

    Ann Thorac Surg

    (2002)
  • W. Ehrlich et al.

    Do patients want minimally invasive aortic valve replacement?

    Eur J Cardiothorac Surg

    (2000)
  • J. Liu et al.

    Minimally invasive aortic valve replacement (AVR) compared to standard AVR

    Eur J Cardiothorac Surg

    (1999)
  • Cited by (171)

    • Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery

      2023, Journal of Thoracic and Cardiovascular Surgery
      Citation Excerpt :

      Significant immediate postoperative benefits associated with MS versus MT resulted in a significantly lower 30-day mortality and reduced ICU and hospital length of stay. Particularly, the 30-day mortality is similar to other reports presented in the literature,11,19,22,23 with slightly better outcomes compared with other clinical studies.7,15,24 Some clinical studies reported different results evidencing the lack of differences between MS and MT in perioperative outcomes18,19,23 or slightly in favor of MT22,25 or MS. Our results confirm these findings according to the most recent reports3,10,11 and meta-analysis.9,21,26

    View all citing articles on Scopus
    View full text