Partial upper sternotomy <i>vs</i> full median sternotomy in obese patients undergoing aortic valve replacement: A meta-analysis
Bibliographic record
Abstract
BACKGROUND Obese patients (body mass index ≥ 30 kg/m²) undergoing isolated aortic valve replacement (AVR) face increased surgical risks due to comorbidities. Partial upper sternotomy (PUS), a minimally invasive approach, may reduce complications compared to full median sternotomy (FMS). We hypothesize that PUS improves outcomes over FMS in obese patients undergoing AVR. AIM To compare the efficacy and safety of PUS vs FMS in obese patients undergoing isolated AVR. METHODS This systematic review and meta-analysis followed PRISMA guidelines, searching PubMed, EMBASE, and Cochrane databases for observational studies comparing PUS vs FMS in obese patients undergoing AVR. Outcomes were analyzed using odds ratios (OR), mean differences (MD), 95% confidence intervals (CI), I ² statistic, and Newcastle-Ottawa Scale was used for quality assessment. RESULTS Four observational studies involving 677 patients were analyzed. PUS reduced intensive care unit stay (MD -2.67 days, 95%CI: -4.43 to -0.90, P = 0.003, I ² = 78%) but increased cardiopulmonary bypass time (MD 5.62 minutes, 95%CI: -0.36 to 11.59, I ² = 55%). No differences were observed in renal failure (OR 1.13, 95%CI: 0.63-2.94, I ² = 0%), atrial fibrillation (OR 0.81, 95%CI: 0.43-1.54, I ² = 30%), reexploration (OR 1.09, 95%CI: 0.48-2.47, I ² = 0%), postoperative bleeding (OR 1.48, 95%CI: 0.53-4.15, I ² = 60%), wound infection (OR 1.23, 95%CI: 0.70-2.14, I ² = 0%), hospital stay (MD 0.51 days, 95%CI: -4.13 to 5.15, I ² = 90%), or cross-clamp time (MD 4.03 minutes, 95%CI: -0.75 to 8.80, I ² = 50%). CONCLUSION PUS is safe and effective for obese patients undergoing AVR, reducing intensive care unit stay and enhancing recovery, provided surgical expertise is available.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".