Minimally Invasive Versus Sternotomy in Redo Mitral Valve Surgery: Short- and Long-Term Outcomes with Meta-Regression and Time-to-Event Analysis.

In 30 seconds

This meta-analysis compared minimally invasive mitral valve surgery (MI-MVS) with sternotomy for redo surgery in adults. It included 15 studies and 3457 patients, pooling perioperative outcomes and reconstructing patient-level time-to-event data from Kaplan-Meier curves. MI-MVS was associated with lower perioperative mortality (OR, 0.33 [95% CI, 0.23-0.48]; P <0.001) and better overall survival (HR, 0.74 [95% CI, 0.62-0.89]; P =0.001). However, the survival difference was attenuated in propensity-matched analyses, leaving uncertainty about whether it reflects the procedure or baseline risk.

Key findings

• Perioperative mortality was lower with MI-MVS than sternotomy (OR, 0.33 [95% CI, 0.23-0.48]; P <0.001).
• MI-MVS was associated with fewer reoperations (OR, 0.65 [95% CI, 0.44-0.98]; P =0.04) and less acute kidney injury (OR, 0.58 [95% CI, 0.39-0.87]; P =0.008).
• Time-to-event analysis favored MI-MVS for survival (HR, 0.74 [95% CI, 0.62-0.89]; P =0.001), but the difference was attenuated in propensity-matched analysis.
• Stroke and arrhythmia rates were similar between approaches.

Why it matters

Redo mitral surgery is high risk, and these pooled findings suggest that minimally invasive access may be associated with better perioperative outcomes without an apparent long-term survival penalty. The attenuation of the survival association after propensity matching is clinically important: it cautions against interpreting the overall survival result as a procedural benefit and highlights the potential influence of patient selection and baseline risk.

What to keep in mind

The evidence comes from pooled studies rather than a reported randomised comparison. Long-term survival estimates were reconstructed from Kaplan-Meier curves, and the survival difference was attenuated in propensity-matched analyses.