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Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: a Bayesian network meta-analysis

  
@article{ACS4307,
	author = {Kevin Phan and Ashleigh Xie and Yi-Chin Tsai and Deborah Black and Marco Di Eusanio and Tristan D. Yan},
	title = {Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: a Bayesian network meta-analysis},
	journal = {Annals of Cardiothoracic Surgery},
	volume = {4},
	number = {1},
	year = {2014},
	keywords = {},
	abstract = {Background: Establishing the relative merits of ministernotomy (MS) and minithoracotomy (MT) approaches to minimally invasive aortic valve replacement (MIAVR) is difficult given the limited available direct evidence. Network meta-analysis is a Bayesian approach that can combine direct and indirect evidence to better define the benefits and risks of MS and MT.
Methods: Electronic searches were performed using six databases from their inception to June 2014. Relevant studies utilizing a minimally invasive approach for aortic valve replacement were identified. Data were extracted and analyzed according to predefined clinical endpoints. Both traditional and Bayesian meta-analysis approaches were conducted.
Results: Compared to full sternotomy, MT was associated with longer cardiopulmonary bypass (CPB) duration (WMD, 9.99; 95% CI, 3.91, 16.07; I2=55%; P=0.001) and cross-clamp duration (WMD, 7.64; 95% CI, 2.86, 12.42; P=0.002; I2=74%). When compared to MS using network meta-analysis, no significant difference in duration was detected. Postoperative outcomes including 30-day mortality, stroke, and reoperation for bleeding and wound infection were comparable between MS and MT using both traditional and Bayesian meta-analysis techniques.
Conclusions: The current evidence demonstrates that MIAVR via MS or MT is a safe and efficacious alternative to conventional median sternotomy. MT may be associated with longer CPB and cross-clamp durations, but has similar post-operative outcomes compared to MS. An individualized approach tailored to both the patient and surgical team is likely to provide optimal outcomes.},
	issn = {2225-319X},	url = {http://www.annalscts.com/article/view/4307}
}