New onset of atrial fibrillation in aortic valve replacement by totally endoscopic approach versus minimal invasive aortic valve surgery

Introduction Atrial fibrillation (AF) is an important complication after major cardiac surgeries on the aortic valve, and nowadays, with more minimal invasive procedures, it is still remaining one of the common arrhythmias in patients, despite AF history or new AF. The available data on new directions in the treatment of severe aortic valve disease are limited about new-onset AF, with a few centers reporting promising results. Our study proposes to evidentiate the arrhythmogenic substrate of totally endoscopic surgery versus mini-sternotomy or mini-thoracotomy aortic valve replacement. Methods A systematic search of PubMed, Embase, and the Cochrane Library was conducted for studies comparing totally endoscopic with minimally invasive aortic valve replacement (Figure 1), where we analysed three published studies with 1049 patients. 479 of them had totally endoscopic AVR (TEAVR), while 570 had minimally invasive AVR (MAVR). Eligibility criteria included reporting of event rates (e.g., mortality, complications) for both techniques. Data were extracted for study characteristics and outcomes. Odds ratios were calculated using a random-effects model (Hartung–Knapp–Sidik–Jonkman), and between-study variance (Tau^2) was estimated by restricted maximum-likelihood. Heterogeneity was assessed by Chi^2, p value, and I^2 statistics. Results A total of three studies (n=969) contributed data comparing totally endoscopic versus minimally invasive aortic valve replacement, yielding 399 and 570 patients in each arm, respectively. The pooled odds ratio was 0.91 (95% CI 0.33–2.50; p=0.74), indicating no significant difference in events between groups. Between-study heterogeneity was negligible (I^2=0%). These findings suggest that totally endoscopic and minimally invasive approaches confer similar outcomes for the assessed endpoint. Conclusions Our analysis shows that there are no statistical differences between the new-onset of AF in TEAVR and MAVR.