title: Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: a Bayesian network meta-analysis.
abstract: BACKGROUND
  Establishing the relative merits of ministernotomy (MS) and minithoracotomy (MT) approaches to minimally invasive aortic valve replacement (MIAVR) is difficult given the limited available direct evidence. Network meta-analysis is a Bayesian approach that can combine direct and indirect evidence to better define the benefits and risks of MS and MT.
  
  
  METHODS
  Electronic searches were performed using six databases from their inception to June 2014. Relevant studies utilizing a minimally invasive approach for aortic valve replacement were identified. Data were extracted and analyzed according to predefined clinical endpoints. Both traditional and Bayesian meta-analysis approaches were conducted.
  
  
  RESULTS
  Compared to full sternotomy, MT was associated with longer cardiopulmonary bypass (CPB) duration (WMD, 9.99; 95% CI, 3.91, 16.07; I(2)=55%; P=0.001) and cross-clamp duration (WMD, 7.64; 95% CI, 2.86, 12.42; P=0.002; I(2)=74%). When compared to MS using network meta-analysis, no significant difference in duration was detected. Postoperative outcomes including 30-day mortality, stroke, and reoperation for bleeding and wound infection were comparable between MS and MT using both traditional and Bayesian meta-analysis techniques.
  
  
  CONCLUSIONS
  The current evidence demonstrates that MIAVR via MS or MT is a safe and efficacious alternative to conventional median sternotomy. MT may be associated with longer CPB and cross-clamp durations, but has similar post-operative outcomes compared to MS. An individualized approach tailored to both the patient and surgical team is likely to provide optimal outcomes.
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 5 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 6 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 5 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 6 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Xie
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 5 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 6 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Yi-Chin
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 5 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 6 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 5 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 6 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 5 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 6 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
keywords: Aortic valve replacement; Bayesian; ministernotomy; minithoracotomy; network meta-analysis