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

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{\textquoteright}s mitral valve diseaseMethods: 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.