Minimal access versus sternotomy for complex mitral valve repair: A meta-analysis

Marco Moscarelli, Khalil Fattouch, Mario Gaudino, Giuseppe Nasso, Dodo Paparella, Prakash Punjabi, Thanos Athanasiou, Umberto Benedetto, Gianni D Angelini, Giuseppe Santarpino, Giuseppe Speziale

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

29 Citations (Scopus)


Background:There is high demand for minimally invasive mitral valve repair; however, it is unclear whether the minimally invasive approach provides the same performance of conventional sternotomy in a context of complex mitral valve disease. Here, we compared outcomes of minimally invasive and sternotomy procedures for bileaflet and Barlow’s mitral valve disease
Methods: We performed a pooled meta-analysis of studies reporting early and late follow-up of mitral valve repair for complex mitral valve regurgitation (MR). The primary outcome was moderate MR recurrence and need for re-operation. Secondary outcomes included: operation time, reopening for bleeding, associated tricuspid procedures, failed repair, and in-hospital mortality. Incidence rates (IRs) were calculated for long-term follow-up. Effect estimates were calculated as IRs with 95% confidence intervals. When Kaplan-Meier curves were available, event rates were estimated from the curves with Plot Digitizer software; otherwise, reported event rates were used to calculate IRs.
Results: Eighteen studies including 1905 patients (654 minimally invasive and 1251 sternotomy) with a mean follow-up of 51.6 months (range, 14–138 months) were meta-analyzed with a random model. There were no significant between-group differences in moderate MR recurrence and re-operation (minimally invasive vs. sternotomy, 1.7%, [1.0–2.9%] vs. 1.3% [0.9–1.8%], p = 0.22). Patients in the minimally invasive group were exposed to significantly longer cross clamp and cardiopulmonary bypass times (p < 0.01); however, there were no additional between-group differences in secondary outcomes.
Conclusions: This is the first meta-analysis to demonstrate that minimally invasive and sternotomy approaches produce comparable results for complex mitral valve repair.
Original languageEnglish
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number3
Early online date31 Aug 2019
Publication statusPublished - Mar 2020

Structured keywords

  • Centre for Surgical Research
  • Bristol Heart Institute


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