Introduction
Methods
Inclusion criteria
Exclusion criteria
End-points
Study quality appraisal
Data analysis
Results
Study selection
Author | Date of publication | Study period | Origin of series | Propensity matched (PM) or Randomized (Rand) | Sternotomy approach (N) | Mini-thoracotomy approach (N) | Robotic Enhancement (Y/N) |
---|---|---|---|---|---|---|---|
Grossi et al. [10] | 2014 | 2007–2011 | Database | PM | 367 | 367 | N |
Nasso et al. [11] | 2014 | 2008–2013 | Multicentric | Rand | 80 | 80 | N |
Nishi et al. [12] | 2015 | 2008–2012 | Database | PM | 750 | 750 | N |
Downs et al. [13] | 2016 | 2011–2014 | Database | PM | 355 | 355 | N |
Hawkins et al. [14] | 2018 | 2011–2016 | Unicentric | PM | 74 | 74 | N |
Wang Q et al. [15] | 2018 | 2012–2015 | Unicentric | PM | 67 | 67 | N |
Grant et al. [16] | 2019 | 2008–2016 | Multicentric | PM | 639 | 639 | N |
Liu et al. [17] | 2019 | 2012–2015 | Unicentric | PM | 202 | 202 | N |
Paparella et al. [18] | 2020 | 2011–2017 | Multicentric | PM | 1493 | 1493 | N |
Cetinkaya et al. [19] | 2021 | 2005–2015 | Unicentric | PM | 422 | 422 | N |
Pojar et al. [20] | 2021 | 2012–2018 | Unicentric | PM | 225 | 158 | N |
Olsthoorn et al. [21] | 2022 | 2013–2018 | Multicentric | PM | 718 | 718 | N |
Mihaljevic et al. [22] | 2011 | 2006–2009 | Unicentric | PM | 106 | 106 | Y |
Suri et al. [23] | 2011 | 2007–2010 | Unicentric | PM | 95 | 95 | Y |
Iyigun et al. [24] | 2017 | 2013–2015 | Unicentric | Rand | 29 | 33 | Y |
Hawkins et al. [25] | 2018 | 2011–2016 | Database | PM | 314 | 314 | Y |
Wang A et al. [26] | 2018 | 2011–2014 | Database | PM | 503 | 503 | Y |
Coyan et al. [27] | 2018 | 2013–2015 | Unicentric | PM | 91 | 91 | Y |
Baseline characteristics
Author | Age | Male Gender (%) | NYHA class 3–4 (%) | Hypertension (%) | Coronary Disease (%) | Cerebro-vascular events (%) | Atrial fibrillation (%) | LV impairment (%) | LVEF (%) |
---|---|---|---|---|---|---|---|---|---|
Grossi et al. [10] | 65* | 56.1 | NI | NI | NI | NI | NI | NI | NI |
Nasso et al. [11] | 54.1 ± 10.5 | 56.8 | 26.8 | NI | NI | NI | NI | 26.8 | NI |
Nishi et al. [12] | 55.5 ± 12.6 | 59.8 | 11.3 | 41.6 | NI | 2.8 | NI | 11 | NI |
Downs et al. [13] | 58.1 ± 13.5 | 60.6 | 19.4 | 56.8 | NI | NI | NI | NI | 57.9 ± 9.6 |
Hawkins et al. [14] | 61.6 ± 13.8 | 57.4 | NI | 60.1 | 14.1 | 10.1 | 39.9 | NI | 60 |
Wang Q et al. [15] | 51 ± 12 | 51.5 | 26.9 | 22.4 | NI | 2.2 | 39.5 | NI | 55.9 ± 12 |
Grant et al. [16] | 62.8 ± 12.6 | 66.4 | 47.6 | 45.6 | 5.9 | 2.7 | 33.6 | 17.5 | NI |
Liu et al. [17] | 50.7 ± 11.5 | 34.6 | 26.9 | 6.9 | 2.2 | 6.7 | 49.2 | NI | 62.8 ± 7.9 |
Paparella et al. [18] | 66.5 ± 12 | 48.9 | NI | 62 | 6.5 | 1 | 29.2 | 26.6 | NI |
Cetinkaya et al. [19] | 64.1 ± 12.7 | 54.7 | 84.8 | 49.5 | 7.7 | 5.2 | 33.4 | NI | 57.5* |
Pojar et al. [20] | 65.1 ± 10.1 | 41.5 | 43.3 | 73 | NI | 8.1 | 44.3 | NI | 58.4 ± 10.7 |
Olsthoorn et al. [21] | 63.6 ± 12 | 57 | NI | NI | NI | NI | NI | 14.6 | NI |
Mihaljevic et al. [22] | 61 ± 11 | 75 | 20 | 46 | NI | 1.8 | 7 | NI | NI |
Suri et al. [23] | 55.3 ± 12.6 | 78.4 | 10 | 32.1 | 1.6 | 0.5 | 4.7 | NI | 65.3 ± 6.2 |
Iyigun et al. [24] | 49.9 ± 13.7 | 32.2 | NI | NI | NI | NI | NI | NI | NI |
Hawkins et al. [25] | 61* | 58.1 | NI | 63.2 | 14.9 | 6.2 | 10.8 | NI | 60* |
Wang A et al. [26] | 71 ± 5 | 61 | 44.9 | 68.2 | 7.4 | 3.4 | 14.4 | NI | 59 ± 8 |
Coyan et al. [27] | 62* | 56 | 32 | 57 | NI | 10 | 26 | NI | 59* |
Author | Risk score | MV Repair (%) | MV replacement (%) | Associated TV repair (%) | Associated AF surgery (%) | Follow-up (years) |
---|---|---|---|---|---|---|
Grossi et al. [10] | NI | 100 | 0 | NI | NI | NI |
Nasso et al. [11] | NI | 100 | 0 | NI | NI | 3.2 ± 1.4 |
Nishi et al. [12] | NI | 100 | 0 | NI | NI | NI |
Downs et al. [13] | 1.75 ± 3.9a | 77.9 | 22.1 | NI | 27.3 | NI |
Hawkins et al. [14] | NI | 73.3 | 26.7 | 9.4 | 37.8 | NI |
Wang Q et al. [15] | 3.17 ± 1.2b | 100 | 0 | 70.1 | 23.9 | 2.8* |
Grant et al. [16] | 5.4 ± 5.7c | 84.1 | 15.9 | 8.05 | 17.1 | 3.7* |
Liu et al. [17] | 1.34 ± 0.67d | 0 | 100 | 93.8 | NI | 2.2 ± 1.1 |
Paparella et al. [18] | 2.6 ± 2.96d | 65.2 | 34.8 | 13.7 | NI | NI |
Cetinkaya et al. [19] | 7.6 ± 10.3c | 86.75 | 13.25 | 16.65 | 26.4 | 3 |
Pojar et al. [20] | 2.78 ± 2.4d | 83.8 | 16.2 | 49.3 | 46.7 | 3.6 ± 2.1 |
Olsthoorn et al. [21] | 3b* | 78.6 | 21.4 | 10.7 | 14.1 | 3.2 ± 2 |
Mihaljevic et al. [22] | NI | 100 | 0 | NI | NI | NI |
Suri et al. [23] | NI | 100 | 0 | NI | NI | NI |
Iyigun et al. [24] | NI | 32.2 | 64.8 | 12.9 | NI | NI |
Hawkins et al. [25] | 0.6a* | 82.9 | 17.1 | NI | NI | NI |
Wang A et al. [26] | 2 ± 2a | 94.4 | 5.6 | NI | NI | 1.8 ± 1.2 |
Coyan et al. [27] | 0.8a* | 83.5 | 16.5 | NI | NI | NI |
Mortality
Complications | N | Sample size/Events | Statistics | Heterogeneity | Sub-group homogeneity | Publication bias | |||
---|---|---|---|---|---|---|---|---|---|
MiniTh (n) | Sternotomy (n) | OR | 95% CI p-value | χ2 test p-value | I2 test (%) | Q test p-value | Eggers test p-value | ||
Mortality | 18 | 6467 80 | 6530 110 | 1.37 | 0.96–1.92 0.06 | 0.76 | 8.6 | 0.05 | 0.850 |
Stroke | 16 | 6367 68 | 6434 85 | 1.23 | 0.89–1.70 0.21 | 0.99 | 0 | 0.69 | 0.159 |
Reoperation for bleeding | 14 | 5565 192 | 5632 180 | 0.91 | 0.73–1.12 0.38 | 0.41 | 0 | 0.43 | 0.765 |
Renal failure | 14 | 5881 132 | 5948 202 | 1.67 | 1.06–2.62 0.03 | 0.04 | 46 | 0.81 | 0.276 |
Atrial fibrillation | 14 | 5348 973 | 5415 1232 | 1.31 | 1.15–1.51 0.001 | 0.20 | 37 | 0.74 | 0.108 |
Blood transfusion | 12 | 4756 1155 | 4823 1557 | 1.77 | 1.39–2.27 0.001 | 0.001 | 81 | 0.86 | 0.642 |
Prolonged ventilation | 10 | 3140 96 | 3207 120 | 1.22 | 0.80–1.88 0.36 | 0.07 | 47 | 0.31 | 0.987 |
Wound infection | 10 | 4415 38 | 4482 75 | 1.86 | 1.17–2.96 0.01 | 0.72 | 11 | 0.73 | 0.978 |
Mid-term mortality | 8 | 2519 107 | 2555 164 | 1.50 | 1.09–2.08 0.01 | 0.51 | 24 | 0.72 | 0.174 |
Mid-term reoperation | 7 | 2059 56 | 2106 45 | 0.76 | 0.50–1.15 0.19 | 0.65 | 0 | 0.41 | 0.266 |
Stroke
Other complications
Time related outcomes
Outcomes | N | Sample size | Statistics | Heterogeneity | Sub-group homogeneity | Publication bias | |||
---|---|---|---|---|---|---|---|---|---|
MiniTh (n) | Sternotomy (n) | Diff. in means | 95% CI p-value | χ2 test p-value | I2 test (%) | Q test p-value | Eggers test p-value | ||
Cross-Clamp time, min | 16 | 5382 | 5445 | 20.7 | 14.9/26.4 0.001 | 0.001 | 96 | 0.87 | 0.001 |
CPB time, min | 16 | 5382 | 5445 | 36.8 | 29.8/43.9 0.001 | 0.001 | 95 | 0.67 | 0.001 |
Total operative time, min | 9 | 2173 | 2240 | 37.7 | 19.6/55.8 0.001 | 0.001 | 97 | 0.001 | 0.193 |
Ventilation time, hrs | 8 | 1453 | 1520 | − 4.6 | − 10.6/1.4 0.13 | 0.001 | 99 | 0.001 | 0.469 |
ICU stay, days | 14 | 4637 | 4700 | − 0.6 | − 1.1/− 0.21 0.001 | 0.001 | 98 | 0.48 | 0.473 |
Hospital stay, days | 17 | 6100 | 6163 | − 1.88 | − 2.72/− 1.05 0.001 | 0.001 | 97 | 0.97 | 0.458 |
Total cost (USD) | 5 | 1045 | 1112 | − 4525 | − 8725/− 326 0.03 | 0.001 | 92 | 0.13 | 0.222 |