Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: a systematic review and meta-analysis of observational studies.

摘要: Reoperative mitral valve surgery (MVS) through a median sternotomy (ST-MVS) can be particularly challenging due to dense adhesions and is known carry substantial risk of injuries vascular structures. These occur in 7-9% cases are associated with increased mortality rates. A valid alternative that could avoid the risks redo ST-MVS right anterolateral minithoracotomy (MT-MVS) approach. The aim this study was quantify effects MT-MVS compared those on morbidity among patients who underwent prior cardiac sternotomy. MEDLINE EMBASE databases were searched 1 November 2017. Data regarding mortality, stroke, reoperation for bleeding length hospital stay extracted submitted meta-analysis using random modelling I2-test heterogeneity. Six retrospective observational studies included, enrolling total 777 patients. In pooled analysis, demonstrated reduced rates standard [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.18-0.96; P = 0.04]. was, moreover, [difference between means -3.81, CI -5.53 -2.08; < 0.0001) (OR 0.32, 0.10-0.99; 0.0488). incidence stroke similar 1.51, 0.65-3.54; 0.34), all absence conclusion, reoperative minimally invasive MVS safe sternotomy, rates, reoperations comparable stroke. However, because existing literature provided limited, low-quality evidence, more methodologically rigorous randomized controlled trials needed.