title: Minimally invasive reoperative aortic valve replacement: a systematic review and meta-analysis.
abstract: BACKGROUND
  With prolonged life expectancy and more frequent use of biological prostheses, an increasingly higher proportion of patients are undergoing aortic valve replacement (AVR) after previous sternotomy. We critically appraised the quantity and quality of evidence to demonstrate the efficacy and safety of the minimally invasive (MIrAVR) versus conventional (CrAVR) approaches for reoperative AVR.
  
  
  METHODS
  Electronic searches were performed using six databases from their inception to April 2014. Relevant studies utilizing a MIrAVR were identified. Data were extracted and analyzed according to predefined clinical endpoints.
  
  
  RESULTS
  Four single-arm and seven comparative observational studies including a total of 441 MIrAVR patients were included for quality assessment, data extraction and analysis. In-hospital mortality ranged from 0-9.5%, and was similar between the MIrAVR and CrAVR groups (RR, 0.77; 95% CI, 0.39-1.54; P=0.46). Stroke rates ranged from 2.6-8% and were also similar between the two cohorts. The rates of pacemaker implantation, renal failure and reoperation for bleeding were not significantly different between the two groups. There were no reports of myocardial infarctions in the included studies. No significant difference in hospital stay was observed for the MIrAVR versus CrAVR group.
  
  
  CONCLUSIONS
  The current literature suggests that MIrAVR has similar efficacy and mortality outcomes compared to CrAVR without compromise to myocardial protection or hospitalization duration. It appears to be a valid alternative option for patients requiring reoperative AVR.
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 4 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 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Jessie J
authors.initials: JJ
authors.lastname: Zhou
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Nithya
authors.initials: N
authors.lastname: Niranjan
authors.affiliation: 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia ; 3 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 4 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 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
keywords: Minimally invasive; aortic valve replacement (AVR); reoperative; systematic review