Comparative effects of minimally invasive approaches vs. conventional for obese patients undergoing aortic valve replacement: a systematic review and network meta-analysis

BMC Cardiovascular Disorders

Research

Mohamed Mamdouh¹  Nadin Amr Abdelrahim²  Latifa Kassem Alaqori³  Mahmoud Tarek Hefnawy⁴  Nour Ahmed⁴  Toka Reda Ahmed⁴  Shadi Alaa Abdelaal⁵  Mohamed Abozaid⁶ 

[1] Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt;Faculty of Medicine, Tanta University, Tanta, Egypt;Faculty of Medicine, University of Aden, Aden, Yemen;Faculty of Medicine, Zagazig University, Zagazig, Egypt;Kharkiv National Medical University, Kharkiv, Ukraine;Mayo Clinic, Rochester, MN, USA;

关键词: Aortic valve replacement;    Obesity;    Minimally invasive approaches;    Mini-sternotomy;    Mini-thoracotomy;   

DOI  :  10.1186/s12872-023-03410-9

 received in 2023-05-31, accepted in 2023-07-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMinimally invasive approaches like mini-thoracotomy and mini-sternotomy for Aortic Valve Replacement (AVR) showed impressive outcomes. However, their advantages for obese patients are questionable. We aimed in this network meta-analysis to compare three surgical approaches: Full sternotomy (FS), Mini-sternotomy (MS), and Mini-thoracotomy (MT) for obese patients undergoing AVR.MethodsWe followed the PRISMA extension for this network meta-analysis. PubMed/Medline, Scopus, Web of Science, and Cochrane searched through March 2023 for relevant articles. The analysis was performed using R version 4.2.3.ResultsOut of 344, 8 articles met the criteria with 1392 patients. The main outcomes assessed were perioperative mortality, re-exploration, atrial fibrillation, renal failure, ICU stay, hospital stay, cross-clamp time, and bypass time. In favor of MS, the length of ICU stay and hospital stay was significantly lower than for FS [MD -0.84, 95%CI (-1.26; -0.43)], and [MD -2.56, 95%CI (-3.90; -1.22)], respectively. Regarding peri-operative mortality, FS showed a significantly higher risk compared to MS [RR 2.28, 95%CI (1.01;5.16)]. Also, patients who underwent minimally invasive approaches; MT and MS, required less need of re-exploration compared to FS [RR 0.10, 95%CI (0.02;0.45)], and [RR 0.33, 95%CI (0.14;0.79)], respectively. However, Intraoperative timings; including aortic cross-clamp, and cardiopulmonary bypass time, were significantly lower with FS than for MS [MD -9.16, 95%CI (-1.88; -16.45)], [MD -9.61, 95%CI (-18.64; -0.59)], respectively.ConclusionOur network meta-analysis shows that minimally invasive approaches offer some advantages for obese patients undergoing AVR over full sternotomy. Suggesting that these approaches might be considered more beneficial alternatives for obese patients undergoing AVR.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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