Comparative outcomes of minimally invasive right anterior mini-thoracotomy vs conventional sternotomy in aortic valve replacement: a propensity matched meta-analysis.

Background: Aortic valve replacement (AVR) is the standard intervention for treating aortic valve pathologies like aortic stenosis, with conventional sternotomy (CS) being the standard approach. Despite its efficacy, it is associated with post-procedural complications. Hence, a novel minimally invasive procedure called right anterior mini-thoracotomy (RAMT) has emerged, minimizing surgical trauma and enhancing recovery. The emergence of RAMT offers new dimensions to surgical decision-making. Methods: Electronic databases such as PubMed, Cochrane Library, and ScienceDirect were searched from inception to June 2024 for propensity matched studies comparing RAMT with CS for AVR. The Newcastle-Ottawa Scale was used to assess the quality of included studies and to assess the certainty of the outcomes measured, GRADE assessment was performed. Statistical analysis was performed using RevMan (version 5.4.1), and risk ratio (RR) and weighted mean difference (WMD) with 95% CIs were utilized using the random effects model. Results: Five propensity matched retrospective studies encompassing 1691 patients were included. RAMT exhibited superiority in terms of mortality (RR: 0.51; 95% CI: 0.26 to 0.99; P = 0.05) and ventilation time (WMD: -1.19, 95% CI: -2.23 to -0.14; P = 0.03). Conversely, outcomes such as hospital stay, reexploration for bleeding, aortic clamping time, ICU length of stay, atrial fibrillation, infection, stroke, and bypass time demonstrated no statistically significant differences between RAMT and CS. Conclusions: Our study found RAMT a suitable alternative as it effectively reduced early mortality and ventilation time; however, high heterogeneity among the studies and limited data suggest that further research is warranted to confirm its efficacy.