Surgical Outcomes After Minimally Invasive Versus Full Sternotomy Aortic Valve Replacement: Meta-Analysis of 75 Comparative Studies
Bibliographic record
Abstract
Objective: Whether minimally invasive aortic valve replacement (MIAVR) offers an advantage over conventional AVR (CAVR) remains a matter of debate. Although some studies have suggested better postoperative outcomes with MIAVR, technical challenges and longer operative times remain major obstacles to the adoption of these techniques. In this meta-analysis, we compare the reported immediate postoperative outcomes of both approaches. Methods: Cochrane, MEDLINE, and Embase ® databases were searched from inception until January 2022 for studies reporting immediate postoperative outcomes of MIAVR and CAVR. Studies were excluded if they reported on concomitant procedures or enrolled pediatric patients. Random-effects meta-analysis was performed using the restricted maximum likelihood estimator with Hartung–Knapp adjustment. Results: The literature search yielded 3,921 articles, of which 75 were included in this meta-analysis. The most common techniques were ministernotomy and minithoracotomy. MIAVR was associated with lower 30-day mortality than CAVR (odds ratio [OR] = 0.65, 95% confidence interval [CI]: 0.54 to 0.78, I 2 = 0%, P < 0.001). The length of stay (LOS) in the hospital (standardized mean difference [SMD] = −0.44, 95% CI: −0.61 to −0.26, P < 0.001) and in the intensive care unit (SMD = −0.36, 95% CI: −0.57 to −0.15, P < 0.001) were shorter for MIAVR. Individual comparisons of ministernotomy and minithoracotomy to CAVR also yielded similar results. However, aortic cross-clamping and cardiopulmonary bypass times were longer for MIAVR. Conclusions: Our meta-analysis suggests that minimally invasive approaches to AVR may provide advantages beyond cosmesis. Despite longer operative times, MIAVR was associated with earlier recovery and shorter hospital LOS. These findings were consistent for both minithoracotomy and ministernotomy.
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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 | 0.015 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.017 | 0.058 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".