title: Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis.
abstract: OBJECTIVE
  Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS.
  
  
  METHODS
  One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated.
  
  
  RESULTS
  ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events.
  
  
  CONCLUSIONS
  Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.
authors.affiliation: Department of Gynaecology, Zhejiang Cancer Hospital, Hangzhou 310022, China; Department of Cardiovascular Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ding
authors.forename: Da-ming
authors.initials: DM
authors.lastname: Jiang
authors.forename: Kai-yu
authors.initials: KY
authors.lastname: Tao
authors.forename: Qun-jun
authors.initials: QJ
authors.lastname: Duan
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Min-jian
authors.initials: MJ
authors.lastname: Kong
authors.forename: Zhong-hua
authors.initials: ZH
authors.lastname: Shen
authors.forename: Ai-qiang
authors.initials: AQ
authors.lastname: Dong
mesh_terms: D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D056346:Sternotomy / Q000401:mortality*; D015996:Survival Rate; D013908:Thoracotomy / Q000401:mortality*; D016896:Treatment Outcome
keywords: Anterolateral minithoracotomy (ALMT); Median sternotomy (MS); Meta-analysis; Minimally invasive surgical procedures; Mitral valve