Mitral valve surgery via repeat median sternotomy versus right mini-thoracotomy: A systematic review and meta-analysis of clinical outcomes.

BACKGROUND: Redo mitral valve surgeries have high mortality and morbidity and can be physically demanding for patients. Median sternotomy remains the gold standard for most cardiac surgeries. To tackle certain risks with a re-sternotomy, alternative procedures such as the right anterolateral minithoracotomy have been explored. This review aims to compare the clinical outcomes of re-sternotomy (MS) versus right mini thoracotomy (MT) in mitral valve surgery. METHODS: A systematic, electronic search was performed according to Preferred Reporting items for Systematic Reviews and Meta-analysis guidelines to identify relevant articles that compared outcomes of the MS versus MT procedures in patients who have had cardiac surgery via a MS approach. RESULTS: Twelve studies were identified, enrolling 4514 patients. Length of hospital stay(MD = -3.71, 95% confidence interval [CI] [-4.92, -2.49]), 30-day mortality(odds ratio [OR] = 0.59, 95% CI [0.39, 0.90]), and new-onset renal failure(OR = 0.38, 95% CI [0.22, 0.65]) were statistically significant in favor of the MT approach. Infection rates(OR = 0.56, 95% CI[0.25, 1.21]) and length of intensive care unit (ICU) stay (MD = -0.55, 95% CI[-1.16, 0.06]) was lower in the MT group; however, the difference was not significant. No significant differences were observed in the CPB time(MD = -2.33, 95% CI [-8.15, 3.50]), aortic cross-clamp time MD = -1.67, 95% CI[-17.07, 13.76]), and rates of stroke(OR = 1.03, 95% CI[0.55, 1.92]). CONCLUSION: Right MT is a safe alternative to the traditional re-sternotomy for patients who have had previous cardiac surgery. The approach offers a reduced length of hospital stay, ICU stay, and a lower risk of new-onset renal failure requiring dialysis. This review calls for robust trials in the field to further strengthen the evidence.

Robotic coronary artery surgery: Outcomes and pitfalls.

OBJECTIVE: Coronary artery bypass grafting is one of the most commonly performed surgical procedures in cardiovascular surgery with a steadily evolving minimally invasive approach. METHODS: Conventional coronary artery bypass grafting (CABG) is performed traditionally via midline sternotomy. Exciting advancements in technology and engineering over the last two decades have resulted in the transition from conventional to minimally invasive CABG including robotically assisted surgery. RESULTS: The minimally invasive techniques are continuously striving to promote coronary revascularization into the arena of minimally invasive surgery. Examination of 10 previously completed studies with relevant follow-up periods enables an insightful vision into the outcomes and pitfalls surrounding robot-assisted CABG (RACAB) as explored in this review. Studies indicate that RACAB is associated with decreased postoperative complications such as major adverse cardiac or cerebrovascular events without compromise in survival rates. Despite this, certain drawbacks such as incurring costs and technical complexity of the procedure cannot be dismissed. CONCLUSION: There exist patient-related benefits from minimally invasive techniques such as decreased certain postoperative complications. Furthermore, with experience and a specialized stepwise program, it is possible to perform the entire procedure from the console. However, certain pitfalls involving increased expenses, steep learning curve and the lack of proper haptic feedback currently withhold the worldwide expansion of RACAB and limit it to specialized institutions only.