Efficacy Of Minimally Invasive Versus Full Sternotomy Aortic Root Replacement:A Meta-analysis

Objective:To research the efficacy of minimally aortic root replacement(Mini-ARR)and traditional sternotomy aortic root replacement(SARR)in the treatment of aortic root lesions.Methods:The articles comparing the efficacy of Mini-ARR and SARR in the treatment of aortic root lesions were searched in Wanfang database,China Biomedical Literature Database,China knowledge Network,Pub Med,Embase and Cochrane Library database.The publication time of the literature was set from inception until January2021,including prospective or retrospective cohort studies.The outcome indicators were early postoperative mortality,stroke rate,length of stay in intensive care unit and hospital,operation time,aortic cross clamp(ACC)time,cardiopulmonary bypass(CPB)time,ventilator assisted time,rate of re-exploration for bleeding,acute renal failure rate and blood transfusion rates.Results:Eleven studies(10 in English and 1 in Chinese)were enrolled in this Meta-analysis with 3211 patients.Summary analysis showed that:compared with SARR,Mini-ARR has lower postoperative early mortality [OR=0.38,95%CI:0.16-0.93,P=0.03],lower rate of re-exploration for bleeding[OR=0.67,95%CI: 0.46-0.96,P=0.03],lower risk of renal failure[OR=0.37,95%CI:0.21-0.64,P=0.0004],shorter ICU stay [MD=-0.62,95%CI:(-1.05,-0.19),P=0.005],lower rate of blood transfusion[MD=-1.09,95%CI:(-1.91,-0.28),P=0.009].There was no statistical diffe-rence in stroke risk[OR=0.86,95%CI:0.36-2.05,P=0.73],ACC time[MD=-1.93,95%CI:(-9.62,5.75),P=0.62],CPB time,operation time,total hospital stay and ventilator assisted time between Mini-ARR and SARR.Conclusion:Compared with SARR,Mini-ARR has lower postoperative early mortality,shorter stay in ICU,lower rate of re-exploration for bleeding,lower rate of blood transfusion and lower risk of acute renal failure.Mini-ARR is a safe alternative to SARR,and Mini-ARR is superior to SARR in some clinical aspects.