PMID- 19156237
OWN - NLM
STAT- MEDLINE
DCOM- 20090819
LR  - 20211020
IS  - 1526-6702 (Electronic)
IS  - 0730-2347 (Print)
IS  - 0730-2347 (Linking)
VI  - 35
IP  - 4
DP  - 2008
TI  - Does minimal-access aortic valve replacement reduce the incidence of 
      postoperative atrial fibrillation?
PG  - 428-38
AB  - As the most common sequela of cardiac valvular surgery, atrial fibrillation (AF) 
      has an important impact on postoperative morbidity. Minimal-access aortic valve 
      replacement (AVR), with purported benefits on operative outcomes, has emerged as 
      an alternative to conventional AVR. We used meta-analysis to determine whether 
      minimal access influences the incidence of postoperative AF after AVR. Further, 
      we sought first to evaluate via sensitivity analysis the impact of any 
      differences and to identify the sources of possible heterogeneity between 
      studies; second, we sought to evaluate any indirect effect of minimal-access AVR 
      on other surrogate outcomes related to postoperative AF. We identified 10 studies 
      from 26 comparative randomized and nonrandomized reports that documented the 
      primary outcome of interest: new-onset AF. Overall meta-analysis showed no 
      significant difference between minimal-access and conventional AVR in the 
      incidence of postoperative AF (odds ratio, 0.85; 2,262 patients; P=0.24; 95% 
      confidence interval, 0.66-1.11). Nor were there any apparent differences in 
      surrogate outcome measures of intensive care unit stay, total length of stay, or 
      stroke among studies that displayed a notable difference in AF incidence between 
      groups. Sensitivity analysis that included only high-quality studies similarly 
      showed no significant difference in the incidence of AF and further showed 
      several intraoperative variables as potential sources of heterogeneity between 
      studies. Therefore, minimal access may not have a significant effect on 
      postoperative AF. Future randomized studies must take into account the potential 
      sources of heterogeneity identified here to better demonstrate any differences 
      between the 2 approaches in the onset of AF.
FAU - Murtuza, Bari
AU  - Murtuza B
AD  - Department of Cardiothoracic Surgery, St Mary's Hospital Faculty of Medicine, 
      Imperial College, London W2 1NY, United Kingdom. b.murtuza@imperial.ac.uk
FAU - Pepper, John R
AU  - Pepper JR
FAU - Stanbridge, Rex DeL
AU  - Stanbridge RD
FAU - Darzi, Ara
AU  - Darzi A
FAU - Athanasiou, Thanos
AU  - Athanasiou T
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - United States
TA  - Tex Heart Inst J
JT  - Texas Heart Institute journal
JID - 8214622
SB  - IM
MH  - Aortic Valve/pathology/*surgery
MH  - Aortic Valve Insufficiency/pathology/*surgery
MH  - Atrial Fibrillation/epidemiology/etiology/*prevention & control
MH  - Confidence Intervals
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods
MH  - Humans
MH  - Incidence
MH  - Odds Ratio
MH  - Postoperative Complications/*prevention & control
MH  - Risk Factors
MH  - Sensitivity and Specificity
MH  - United Kingdom/epidemiology
MH  - United States/epidemiology
PMC - PMC2607094
OTO - NOTNLM
OT  - Aortic valve/surgery
OT  - aortic valve stenosis/surgery
OT  - atrial fibrillation/etiology/prevention & control
OT  - postoperative complications
OT  - surgical procedures, minimally invasive
EDAT- 2009/01/22 09:00
MHDA- 2009/08/20 09:00
PMCR- 2008/01/01
CRDT- 2009/01/22 09:00
PHST- 2009/01/22 09:00 [entrez]
PHST- 2009/01/22 09:00 [pubmed]
PHST- 2009/08/20 09:00 [medline]
PHST- 2008/01/01 00:00 [pmc-release]
AID - 0010801-200812000-00012 [pii]
PST - ppublish
SO  - Tex Heart Inst J. 2008;35(4):428-38.