title: Minimally invasive cardiac surgery: A systematic review and meta-analysis.
abstract: BACKGROUND
  Minimally invasive (MI) cardiac surgery was introduced to reduce problems associated with a full sternotomy. This meta-analysis aimed to investigate the effects of minimally invasive cardiac surgery on a range of clinical outcomes.
  
  
  METHODS
  To identify potential studies (randomised/prospective clinical trials) systematic searches were carried out. The search strategy included the concepts of "minimally invasive" OR "MIDCAB" AND "coronary artery bypass grafting" OR "cardiac surgery". This was followed by a meta-analysis investigating cross-clamp time, cardiopulmonary bypass (CPB) time, operation time, ventilation time, intensive care unit (ICU) stay, hospital stay, incidence of myocardial infarction and of stroke/neurologic complications.
  
  
  RESULTS
  Eight studies (9 intervention groups), totalling 596 participants were analysed. MI cardiac surgery was associated with a shorter ICU stay mean difference (MD) -0.7days (95% confidence interval (CI) -1.23 to -0.18, p=0.009) and longer cross-clamp MD 6.7min (95% CI 1.24 to 12.17, p=0.02), CPB MD 26.68min (95% CI 10.31 to 43.05, p=0.001), and operation times MD 55.03min (95% CI 22.76 to 87.31, p=0.0008). However no differences were found in the ventilation time MD -3.94h (95% CI -8.09 to 0.21, p=0.06), length of hospital stay MD -1.14days (95% CI -3.11 to 0.83, p=0.26) and in the incidence of myocardial infarction odds ratio (OR) 1.97 (95% CI 0.49 to 7.9, p=0.34) or stroke/neurologic complications OR 0.67 (95% CI 0.11 to 4.05, p=0.66).
  
  
  CONCLUSIONS
  Minimally invasive cardiac surgery is as safe as conventional surgery and could reduce costs due to a shorter period spent in ICU.
authors.affiliation: School of Science and Technology, University of New England, Armidale, NSW 2350, Australia.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Dieberg
authors.affiliation: School of Science and Technology, University of New England, Armidale, NSW 2350, Australia.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Smart
authors.affiliation: School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth PL4 8AA, UK. Electronic address: nicola.king@plymouth.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: King
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000379:methods
keywords: Cardiac surgery; Cardiopulmonary bypass time; ICU stay; Minimally invasive