Key result
Minimally invasive mitral valve surgery cuts operative mortality ~46% versus redo sternotomy after prior cardiac surgery.
Why the study?
Repeat cardiac surgery carries high morbidity and mortality, but the comparative outcomes of redo median sternotomy versus minimally invasive mitral valve surgery in patients needing repeat mitral valve surgery warranted evaluation.
Does minimally invasive mitral valve surgery improve outcomes compared to conventional redo median sternotomy in patients with previous cardiac surgery requiring mitral valve surgery?
Meta-Analysis (n=4,157)
Does minimally invasive mitral valve surgery improve outcomes compared to conventional redo median sternotomy in patients with previous cardiac surgery requiring mitral valve surgery?
In patients with prior cardiac surgery requiring mitral valve surgery, a minimally invasive approach may reduce mortality, hospital stay, and AKI risk compared to conventional redo sternotomy, though data is limited to retrospective studies.
Answers are grounded in this paper and cite their sources.
May reduce operative mortality in redo mitral surgery; leaves open need for randomized confirmation.
Background: The heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population. Methods: We searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model. Results: We included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37-0.80), length of hospital stay (MD, -4.23; 95% CI, -5.77 to -2.68), length of intensive care unit (ICU) stay (MD, -2.02; 95% CI, -3.17 to -0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05). Conclusion: The current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.
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Tariq et al. (2023) conducted a meta-analysis in Mitral valve disease requiring surgery with previous cardiac surgery (n=4,157). Minimally invasive mitral valve surgery (MIMVS) vs. Redo median sternotomy (MS) was evaluated on Operative mortality (RR 0.54, 95% CI 0.37-0.80, p=<0.001). Minimally invasive mitral valve surgery significantly reduced the risk of operative mortality (RR 0.54) compared to redo median sternotomy in patients with previous cardiac surgery.
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