The following is a summary of “Comparative effects of minimally invasive approaches vs. conventional for obese patients undergoing aortic valve replacement: a systematic review and network meta-analysis,” published in the August 2023 issue of Cardiology by Abdelaal et al.

In the retrospective study, researchers aimed to examine the three surgical procedures: Full sternotomy (FS), Mini-sternotomy (MS), and Mini-thoracotomy (MT), if they were effective for obese patients who were undergoing Aortic Valve Replacement (AVR). MS and MT demonstrated effective results for AVR.

The study adhered to PRISMA guidelines, and analysis was conducted using R version 4.2.3. Among 344 articles, only 8 met the criteria, involving 1,392 patients. The study’s primary outcomes were perioperative mortality, atrial fibrillation, re-exploration, renal failure, hospital stay, cross-clamp time, ICU stay, and bypass time. The duration of ICU and hospital stay was lower in MS as compared to FS [MD -0.84, 95%CI (-1.26; -0.43)], and [MD -2.56, 95%CI (-3.90; -1.22)]. However, FS indicated a higher risk for perioperative mortality than MS [RR 2.28, 95%CI (1.01;5.16)]. Additionally, patients who underwent MT and MS exhibited lower re-exploration rates compared to FS [RR 0.10, 95%CI (0.02;0.45)], and [RR 0.33, 95%CI (0.14;0.79)]. However, in the case of FS, cardiopulmonary bypass time and aortic cross-clamp were reduced as compared to MS [MD -9.16, 95%CI (-1.88; -16.45)], [MD -9.61, 95%CI (-18.64; -0.59)], respectively.

The study concluded that MS and MT demonstrated advantages over full sternotomy for obese patients undergoing AVR, implying their potential as more beneficial alternatives.

Source: bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-023-03410-9