Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis Morgan L. Brown, MD, Stephen H. McKellar,

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Presentation transcript:

Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis Morgan L. Brown, MD, Stephen H. McKellar, MD, Thoralf M. Sundt, MD, Hartzell V. Schaff, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 3, Pages 670-679.e5 (March 2009) DOI: 10.1016/j.jtcvs.2008.08.010 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Search strategy results. In total, 28 studies were included in this review. κ, Kappa. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Mortality 30 days after operation. This figure demonstrates pooled estimates for 30-day mortality. Estimates less than 1 indicate lower estimated early mortality with ministernotomy approach. This is divided into randomized and observational studies. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Crossclamp time (in minutes). This figure demonstrates pooled estimates for crossclamp time. Estimates greater than 1 indicate shorter crossclamp time with full sternotomy approach (FULL). This is divided into randomized and observational studies. WMD, weighted mean difference; CI, confidence interval; df, degrees of freedom; MINI, ministernotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Cardiopulmonary bypass time (in minutes). This figure demonstrates pooled estimates for cardiopulmonary bypass time. Estimates greater than 1 indicate shorter bypass time with full sternotomy approach (FULL). This is divided into randomized and observational studies. WMD, weighted mean difference; CI, confidence interval; df, degrees of freedom; MINI, ministernotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Time to extubation (in hours). This figure demonstrates pooled estimates for time to extubation. Estimates less than 1 indicate decreased time to extubation with ministernotomy approach (MINI). This is divided into randomized and observational studies. WMD, weighted mean difference; CI, confidence interval; df, degrees of freedom; FULL, full sternotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Blood loss after operation (in milliliters per 24 hours). This figure demonstrates pooled estimates for blood loss after operation. Estimates less than 1 indicate lower volume of blood loss with ministernotomy (MINI) approach. This is divided into randomized and observational studies. WMD, Weighted mean difference; CI, confidence interval; df, degrees of freedom; FULL, full sternotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Sternal complications. This figure demonstrates pooled estimates for sternal complications, including infection and instability. Estimates less than 1 indicate lower sternal complications with ministernotomy approach. This is divided into randomized and observational studies. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Pain scores. This figure demonstrates pooled estimates for postoperative pain scores. Estimates less than 1 indicate less pain with ministernotomy (MINI) approach. This is divided into randomized and observational studies. WMD, Weighted mean difference; CI, confidence interval; df, degrees of freedom; FULL, full sternotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 9 Rate of conversion. This figure demonstrates the estimated rate of conversion from a ministernotomy to full sternotomy approach. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Total operative time (in minutes) Total operative time (in minutes). This figure demonstrates pooled estimates for total operative time. Estimates greater than 1 indicate shorter operative time with full sternotomy approach (FULL). This is divided into randomized and observational studies. WMD, weighted mean difference; CI, confidence interval; df, degrees of freedom; MINI, ministernotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Intensive care unit stay (in days) Intensive care unit stay (in days). This figure demonstrates pooled estimates for stay in intensive care unit. Estimates less than 1 indicate shorter intensive care stay with ministernotomy approach (MINI). This is divided into randomized and observational studies. WMD, weighted mean difference; CI, confidence interval; df, degrees of freedom; FULL, full sternotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Hospital stay(in days) Hospital stay(in days). This figure demonstrates pooled estimates for stay in hospital. Estimates less than 1 indicate shorter hospital stay with ministernotomy approach (MINI). This is divided into randomized and observational studies. WMD, weighted mean difference; CI, confidence interval; df, degrees of freedom; FULL, full sternotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Postoperative atrial fibrillation Postoperative atrial fibrillation. This figure demonstrates pooled estimates for atrial fibrillation after operation. Estimates less than 1 indicate lower estimates of atrial fibrillation after ministernotomy approach (MINI). This is divided into randomized and observational studies. OR, odds ratio; CI, confidence interval; df, degrees of freedom; FULL, full sternotomy. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Postoperative stroke. This figure demonstrates pooled estimates for postoperative stroke. Estimates less than 1 indicate lower estimate of postoperative stroke with ministernotomy approach. This is divided into randomized and observational studies. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 670-679.e5DOI: (10.1016/j.jtcvs.2008.08.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions