Key result
Minimally invasive aortic valve replacement demonstrated acceptable postoperative quality of life, with 8 of 11 included studies identifying better quality of life compared to median sternotomy.
Why the study?
Median sternotomy is the standard approach for aortic valve replacement, but the minimally invasive approach is increasingly adopted, prompting a comprehensive analysis of whether it offers greater quality of life benefits.
Does minimally invasive aortic valve replacement improve postoperative quality of life compared to median sternotomy in patients undergoing aortic valve replacement?
Systematic Review
Does minimally invasive aortic valve replacement improve postoperative quality of life compared to median sternotomy in patients undergoing aortic valve replacement?
Minimally invasive aortic valve replacement is not inferior to median sternotomy in terms of postoperative quality of life, with some evidence suggesting potential superiority, though high-quality RCTs are needed.
OBJECTIVE: Aortic valve replacement surgery (AVR) via median sternotomy (MS) is the standard surgical intervention used for AVR. However, the minimally invasive approach is becoming more widely adopted. This review focuses on quality of life (QoL) after minimally invasive AVR (MIAVR). The aim of this review is to comprehensively analyze the current body of evidence for QoL after MIAVR. A second aim is to determine whether a conclusion can be made based on the literature to indicate whether MIAVR is more beneficial to the patient compared with MS and should be the preferred approach. METHODS: A literature search was conducted in the PubMed database using relevant searches. Papers were either included or excluded based on their title. Through a cross-reference check from the papers identified by the search, further articles were identified. Initially, 375 manuscript titles and abstracts were screened, with 11 being included in this review. RESULTS: The 11 studies comparing postoperative QoL between MIAVR and MS were comprehensively analyzed. Three studies showed no significant differences between the groups; however, 8 identified better QoL after surgery in the MIAVR group. Three studies investigated pulmonary function after MIAVR and MS, concluding that MIAVR demonstrated superior pulmonary function. CONCLUSIONS: Overall, MIAVR can be performed with acceptable postoperative QoL. However, the current literature is sparse, and it is not possible to say whether one approach is better than the other. MIAVR is certainly not inferior to MS in terms of QoL. Well-designed, randomized controlled trials are needed to draw more definitive conclusions.
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Hackney et al. (2025) conducted a systematic review in Aortic valve replacement. Minimally invasive aortic valve replacement vs. Median sternotomy was evaluated on Quality of life (QoL). Minimally invasive aortic valve replacement demonstrated acceptable postoperative quality of life, with 8 of 11 included studies identifying better quality of life compared to median sternotomy.
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