Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis

Morgan L. Brown, Stephen H. McKellar, Thoralf M. Sundt, Hartzell V Schaff

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204 Citations (Scopus)

Abstract

Objective: Most aortic valve replacements are by conventional full median sternotomy. Less invasive approaches have been developed with partial upper sternotomy (ministernotomy). Methods: Systematic review and meta-analysis were performed with studies comparing ministernotomy and full sternotomy for aortic valve replacement. Results: Twenty-six studies were selected, with 4586 patients with aortic valve replacement (2054 ministernotomy, 2532 full sternotomy). There was no difference in mortality (odds ratio 0.71, 95% confidence interval 0.49-1.02). Ministernotomy had longer crossclamp and bypass times (weighted mean difference 7.90 minutes, 95% confidence interval 3.50-10.29 minutes, and 11.46 minutes, 95% confidence interval 5.26-17.65 minutes, respectively). Both intensive care unit and hospital stays were shorter with ministernotomy (weighted mean difference -0.46 days, 95% confidence interval -0.72 to -0.20 days, and -0.91 days, 95% confidence interval -1.45 to -0.37 days, respectively). Ministernotomy had shorter ventilation time and less blood loss within 24 hours (weighted mean difference -2.1 hours, 95% confidence interval -2.95 to -1.30 hours, and -79 mL, 95% confidence interval -23 to 136 mL, respectively). Randomized studies tended to demonstrate no difference between ministernotomy and full sternotomy. Rate of conversion from partial to conventional sternotomy was 3.0% (95% confidence interval 1.8%-.4%). Conclusion: Ministernotomy can be performed safely for aortic valve replacement, without increased risk of death or other major complication; however, few objective advantages have been shown. Surgeons must conduct well-designed, prospective studies of relevant, consistent clinical outcomes to determine the role of ministernotomy in cardiac surgery.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number3
DOIs
StatePublished - Mar 2009

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Sternotomy
Aortic Valve
Meta-Analysis
Confidence Intervals
Thoracic Surgery
Intensive Care Units
Ventilation
Length of Stay
Odds Ratio
Prospective Studies
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

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Ministernotomy versus conventional sternotomy for aortic valve replacement : A systematic review and meta-analysis. / Brown, Morgan L.; McKellar, Stephen H.; Sundt, Thoralf M.; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 137, No. 3, 03.2009.

Research output: Contribution to journalArticle

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abstract = "Objective: Most aortic valve replacements are by conventional full median sternotomy. Less invasive approaches have been developed with partial upper sternotomy (ministernotomy). Methods: Systematic review and meta-analysis were performed with studies comparing ministernotomy and full sternotomy for aortic valve replacement. Results: Twenty-six studies were selected, with 4586 patients with aortic valve replacement (2054 ministernotomy, 2532 full sternotomy). There was no difference in mortality (odds ratio 0.71, 95{\%} confidence interval 0.49-1.02). Ministernotomy had longer crossclamp and bypass times (weighted mean difference 7.90 minutes, 95{\%} confidence interval 3.50-10.29 minutes, and 11.46 minutes, 95{\%} confidence interval 5.26-17.65 minutes, respectively). Both intensive care unit and hospital stays were shorter with ministernotomy (weighted mean difference -0.46 days, 95{\%} confidence interval -0.72 to -0.20 days, and -0.91 days, 95{\%} confidence interval -1.45 to -0.37 days, respectively). Ministernotomy had shorter ventilation time and less blood loss within 24 hours (weighted mean difference -2.1 hours, 95{\%} confidence interval -2.95 to -1.30 hours, and -79 mL, 95{\%} confidence interval -23 to 136 mL, respectively). Randomized studies tended to demonstrate no difference between ministernotomy and full sternotomy. Rate of conversion from partial to conventional sternotomy was 3.0{\%} (95{\%} confidence interval 1.8{\%}-.4{\%}). Conclusion: Ministernotomy can be performed safely for aortic valve replacement, without increased risk of death or other major complication; however, few objective advantages have been shown. Surgeons must conduct well-designed, prospective studies of relevant, consistent clinical outcomes to determine the role of ministernotomy in cardiac surgery.",
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