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Ann Thorac Surg 2008;85:1121-1131. doi:10.1016/j.athoracsur.2007.09.038
© 2008 The Society of Thoracic Surgeons
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Right arrow Valve disease

Review

Minimal Access Aortic Valve Replacement: Is It Worth It?

Bari Murtuza, PhD, FRCSa,b,c,*, John R. Pepper, FRCSc, Rex DeL Stanbridge, FRCSa, Catherine Jones, BSc, MBBSb, Christopher Rao, MBBSa,b, Ara Darzi, KBE, FRCSb, Thanos Athanasiou, PhD, FETCSa,b

a Department of Cardiothoracic Surgery, St. Mary’s Hospital, Faculty of Medicine, Imperial College, London, England
b Department of Surgical Oncology and Technology, St. Mary’s Hospital, Faculty of Medicine, Imperial College, London, England
c Department of Cardiothoracic Surgery, Royal Brompton Hospital, Faculty of Medicine, Imperial College, London, England

* Address correspondence to Dr Murtuza, Department of Cardiothoracic Surgery, St. Mary’s Hospital, Faculty of Medicine, Imperial College, London, W2 1NY, England (Email: b.murtuza{at}imperial.ac.uk).

Controversy surrounds the use of minimal access aortic valve replacement (AVR). This meta-analytical study quantified the effects of minimal access AVR on morbidity and mortality compared with conventional AVR and evaluated study heterogeneity and robustness of the findings using sensitivity analysis. Overall, meta-analysis suggested marginal benefits in perioperative mortality (4,667 patients; odds ratio, 0.72; 95% confidence interval, 0.51-1.00; p = 0.05), intensive care unit stay, total hospital stay, and ventilation time in the minimal access AVR group, although cross-clamp, cardiopulmonary bypass, and total operation times were longer. Study heterogeneity and apparent benefits in perioperative mortality were related to study quality, athough results for intensive care unit and hospital stay were maintained according to the sensitivity analysis. This suggests that minimal access AVR can be offered on the basis of patient choice and cosmesis rather than evident clinical benefit.




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