Abstract 4370729: Outcomes of Minimally Invasive Versus Conventional Surgery in Mitral Valve Endocarditis: A Systematic Review and Meta-Analysis.

Abstract

Introduction: Surgical intervention is crucial in managing infective endocarditis (IE) of the mitral valve. Conventional sternotomy is the standard approach, but minimally invasive cardiac surgery (MICS) has gained interest as a less invasive alternative. However, its safety and effectiveness in active IE remain uncertain. Therefore, we conducted a meta-analysis to compare outcomes of MICS versus conventional surgery in mitral valve IE. Research Question: Does MICS offer comparable or superior outcomes to conventional sternotomy in patients undergoing mitral valve surgery for IE ? Methods: We searched PubMed, Embase, Web of Science, and Cochrane Central for studies comparing MICS to conventional sternotomy in patients undergoing surgery for IE. The primary outcome was mortality. Secondary outcomes included atrial fibrillation, stroke, renal failure, reoperation, intensive care unit (ICU) stay, and total hospital length of stay (LOS). Data on key outcomes were extracted, and pooled risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Statistical analyses were performed using R Studio, and heterogeneity was assessed using the I 2 statistic. Results: A total of 878 patients from 5 retrospective cohort studies were included. MICS was performed in 243 (27.7%) patients. Compared to conventional surgery, MICS was associated with a significantly shorter LOS (MD - 4.98 days; 95% CI - 9.60 to - 0.36; p < 0.0001; I 2 = 97.1%), and a trend toward shorter ICU stay (MD - 17.21 hours; 95% CI - 35.22 to 0.81; p < 0.0001; I 2 = 97.5%). The risk of postoperative renal failure was significantly lower in the MICS group (RR 0.63; 95% CI 0.41-0.94; p= 0.801; I 2 = 0%). A non-significant trend toward reduced all-cause mortality was observed (RR 0.49; 95% CI 0.23-1.01; p= 0.537; I 2 = 0%). No significant differences were found for atrial fibrillation (RR 0.89; 95% CI 0.21-3.72; p= 0.181; I 2 = 0.4%), reintervention (RR 0.80; 95% CI 0.36 to 1.76; p= 0.708; I 2 = 0%), or stroke (RR 0.60; 95% CI 0.14 to 2.59; p= 0.718; I 2 = 0%). Conclusion: In mitral valve IE, MICS is associated with shorter hospital stay and lower risk of renal complications, with no significant increase in mortality, stroke, or other major adverse events. These findings support its safety and effectiveness as a surgical option in appropriately selected patients, though prospective studies are needed to confirm long-term outcomes.