Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis

ObjectiveMost aortic valve replacements are by conventional full median sternotomy. Less invasive approaches have been developed with partial upper sternotomy (ministernotomy).MethodsSystematic review and meta-analysis were performed with studies comparing ministernotomy and full sternotomy for aortic valve replacement.ResultsTwenty-six studies were selected, with 4586 patients with aortic valve replacement (2054 ministernotomy, 2532 full sternotomy). There was no difference in mortality (odds ratio 0.71, 95% confidence interval 0.49–1.02). Ministernotomy had longer crossclamp and bypass times (weighted mean difference 7.90 minutes, 95% confidence interval 3.50–10.29 minutes, and 11.46 minutes, 95% confidence interval 5.26–17.65 minutes, respectively). Both intensive care unit and hospital stays were shorter with ministernotomy (weighted mean difference −0.46 days, 95% confidence interval −0.72 to −0.20 days, and −0.91 days, 95% confidence interval −1.45 to −0.37 days, respectively). Ministernotomy had shorter ventilation time and less blood loss within 24 hours (weighted mean difference −2.1 hours, 95% confidence interval −2.95 to −1.30 hours, and −79 mL, 95% confidence interval −23 to 136 mL, respectively). Randomized studies tended to demonstrate no difference between ministernotomy and full sternotomy. Rate of conversion from partial to conventional sternotomy was 3.0% (95% confidence interval 1.8%–.4%).ConclusionMinisternotomy can be performed safely for aortic valve replacement, without increased risk of death or other major complication; however, few objective advantages have been shown. Surgeons must conduct well-designed, prospective studies of relevant, consistent clinical outcomes to determine the role of ministernotomy in cardiac surgery