In their recent study, Stevens et al have shown a reverse trend

In their recent study, Stevens et al. have shown a reverse trend in their stroke rate (3.4%��sternotomy approach, 1.2%��videoscopic approach, and 0.7%��robotic mitral valve procedures) [49]. 6. Bleeding Related Complications Transfusion of allogenic red blood cells (RBCs) is recognized as a risk factor for adverse outcome after cardiac surgery [50]. Unnecessary transfusions are likely to be associated with unnecessary morbidity and additional indirect hospitalization costs. Throughout the last decade, one of the major benefits of MIMVS has been claimed to be the less bleeding related complications and less usage of blood products [38, 51�C54] as compared to the conventional sternotomy approach. Other authors have shown no difference in blood requirements in the two different groups [55].

In a recent study, Gammie et al. [48] could not show any difference in reexploration for bleeding in the MIMVS group when compared to the traditional sternotomy group but have shown a statistically significant higher use of perioperative red blood cell (52.6% for the open group and 41% for the MIMVS group) and platelet (25.3% for the open group and 15.8% for the MIMVS group) transfusion. However, when these outcomes were risk aadjusted there was no significant difference in the transfusion of either red blood cell or platelet [48]. Stevens et al. published their recent data with no difference in reexploration for bleeding in the three groups of conventional, videoscopic, and robotic mitral valve surgery (series of 2,255 patients) but with a significant difference in the requirement of blood transfusion (63%��conventional group, 43%��videoscopic, and 18%��robotic mitral valve procedures) [49].

7. Postoperative Atrial Fibrillation (AF) There are conflicting data in the literature regarding the incidence of AF following MIMVS. It has been suggested that a less traumatic surgical approach would be a less potent trigger of postoperative AF. Five of six studies, however, demonstrated this not to be the case [11, 56�C60], and on meta-analysis of four eligible studies, there was no significant difference between minimally invasive and sternotomy approaches (539 patients, OR 0.86, 95% CI 0.59�C1.27, P = 0.45). More recently Gammie et al. [48], however, have shown a decreased incidence of postoperative AF (20.1% for the conventional sternotomy group and 15.

9% for the less invasive group). 8. Septic Complications The incidences of septic complications and wound infections are less in thoracotomy than with sternotomy. Of the three studies of mini-thoracotomy mitral valve surgery that reported wound complications compared to median Entinostat sternotomy, Grossi et al. reported an incidence of 0.9% and 5.7% for mini-thoracotomy and sternotomy cases, respectively (P = 0.05) [61]. This increased to 1.8% and 7.7%, respectively, in elderly patients (P = 0.03) [37]. Santana et al.

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