Mitral valve surgery: Right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis

Objective: To update the current evidence on mitral valve surgery through a lateral minithoracotomy versus median sternotomy. Methods: A comprehensive literature research was performed for studies comparing mitral valve surgery through a right lateral minithoracotomy (MIVS) and median sternotomy in MEDLINE, EMBASE, Cochrane Central, CTSnet, and Google Scholar for the most recent literature up to April 2013. A systematic review and meta-analysis was performed on the studies found in the literature. Results: More than 20,000 patients from 45 studies were included in this study. Stroke rate and all-cause mortality up to 30 days was similar in both groups. The length of stay in the intensive care unit, respirator dependence, and hospital stay were significantly shorter in the MIVS group. Furthermore, blood drainage volume and blood transfusions were decreased in the MIVS group. In contrast, cardiopulmonary bypass time, crossclamp time, and procedure time were longer in the MIVS group. Postoperative new atrial fibrillation was less in the MIVS group. More aortic dissections occurred in the MIVS group. The rates of reexploration and postoperative renal failure were similar in both groups. Conclusions: MIVS and conventional mitral valve surgery have a similar perioperative outcome. Mitral valve surgery via a right lateral minithoracotomy seems to be favorable with regard to resource-related outcome.