Comparative Study of Different Minimally Invasive Aortic Valve Replacement Techniques: A Systematic Review and Network Meta-Analysis
Bibliographic record
Abstract
OBJECTIVES: This investigation aimed to compare different minimally invasive techniques, namely, mini-sternotomy (MS), mini-thoracotomy (MT), and totally thoracoscopic (TT) approaches for the surgical treatment of aortic valve disease, emphasizing their respective benefits and limitations to guide clinical decision-making. METHODS: A systematic search was conducted in Medline, Web of Science, Scopus, Wiley Online Library, Google Scholar, and ProQuest. Studies were appraised using the Newcastle-Ottawa Scale. A frequentist network meta-analysis (NMA) with a random-effects model was employed to give reflective ranks and compare outcomes across techniques. Treatment ranking was based on p-scores, with MS as the reference. Higher p-scores indicate greater certainty of superiority over competing interventions. The primary outcome was mortality. RESULTS: Twenty-five observational studies (n = 34 573 patients) were included. Mortality did not differ between techniques (p-score: MS [0.85] ∼ MT [0.34] ∼ TT [0.31]). TT had longer cardiopulmonary bypass (mean difference [MD]: 41.04 [95% CI, 10.98-71.10]) and cross-clamp times (MD: 30.31 [95% CI, 5.81-54.80]) but offered the shortest intensive care unit (ICU) length of stay (p-score: TT [0.98] > MT [0.51] > MS [0.01]; MD: -16.00 [95% CI, -26.62 to -5.38]), reduced hospital stay (MD: -2.07 [95% CI, -3.77 to -0.37]), and fewer complications, including neurological events (odds ratio: 1.79 [95% CI, 1.03-3.13]), blood loss (MD: 208.85 mL [95% CI, 102.29-315.40]) compared to MS. MT showed similar outcomes to MS, except for longer operative times (MD: 29.84 [95% CI, 8.35-51.32]) and shorter ICU stays (MD: -5.88 [95% CI, -11.10 to -0.67]). CONCLUSIONS: TT may offer advantages such as shorter hospital stays, reduced neurological complications, and less bleeding as compared to MS, although it is associated with longer operative times. However, as all included studies were observational, the findings should be interpreted with caution, and further NMA including only randomized trials is warranted.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.005 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.037 | 0.028 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| 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; both teacher heads agree on what is shown here.
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".