Mini-thoracotomy vs. conventional sternotomy mitral valve surgery: a systematic review and meta-analysis
Bibliographic record
Abstract
INTRODUCTION: Minimal access mitral valve surgery (mini-MVS) approaches are becoming increasingly common. They are thought to be associated with less perioperative bleeding and postoperative pain, resulting in shorter hospital length-of-stay (LOS) and faster return to daily activities. However, there are concerns that this approach may have inferior surgical results - with resultant increases in morbidity and mortality - when compared to conventional mitral valve surgery. To address this gap in the literature, we undertook a systematic review and meta-analysis, comparing right thoracotomy mini-MVS (MT-MVS) to conventional mitral valve surgery using a median sternotomy (sternotomy-MVS) approach. EVIDENCE ACQUISITION: We searched the Cochrane Library, MEDLINE, PubMed, EMBASE and Clinicaltrials.gov for randomized trials comparing MT-MVS to sternotomy-MVS in adults. Outcomes of interest were mortality, stroke, hospital length of stay, bleeding, cardiopulmonary bypass (CPB) and cross-clamp times. Studies reporting reoperation data were excluded. References were screened independently and in duplicate, and studies deemed to be potentially relevant were evaluated for inclusion by full-text review. Risk of bias was assessed using the Cochrane tool. Extracted outcome data were pooled for meta-analysis using RevMAN 5.3. The overall quality of evidence for each outcome was evaluated using the GRADE framework. EVIDENCE SYNTHESIS: Three trials including 280 patients met eligibility criteria. Studies were considered to be at high risk of bias due to lack of blinding and small number of patients. Pooled results showed no significant difference in mortality (RR 0.50, 95% CI [0.05 to 5.39], low quality) or stroke (RR 0.50, 95% CI [0.05 to 5.39], low quality). Technique-related outcomes were also similar: cardiopulmonary bypass (CPB) time (MD 17.72 minutes, 95% CI [-7.22 to 42.67), very low quality), cross-clamp time (MD 5.31 minutes, 95% CI [-14.35 to 24.96), very low quality), and bleeding (MD -148.95 mL, 95% CI [-491.02 to 193.12), low quality). Length of stay was significantly shorter in the mini-MVS group (MD -1.89 days, 95% CI [-3.57 to -0.22], P=0.03, low quality). CONCLUSIONS: MT-MVS does not result in increased morbidity and mortality or procedural duration, and may decrease hospital LOS. Our preliminary results suggest that MT-MVS is a safe and potentially beneficial approach to the surgical management of mitral valve disease. However, current evidence is of low quality and larger, more methodologically rigorous randomized trials are required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.031 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.040 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".