Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta-analysis

Haya Mohammed, M Yousuf Salmasi, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
40 Downloads (Pure)


BACKGROUND: Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta-analysis aims to compare operative and peri-operative outcomes of MIS vs MS in MVD.

METHODS: PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra- and postoperative times, reoperation for bleeding and surgical site infection were evaluated.

RESULTS: Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle-Ottawa scale was good for all included studies. Meta-analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365-0.608; P < .0001). Similarly, aortic cross-clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509-0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay.

CONCLUSIONS: MIS for MVD have similar short-term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.

Original languageEnglish
Number of pages11
JournalJournal of Cardiac Surgery
Early online date19 Apr 2020
Publication statusE-pub ahead of print - 19 Apr 2020

Structured keywords

  • Bristol Heart Institute


  • double valve
  • meta-analysis
  • minimally invasive
  • triple valve


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