This meta-analysis aimed to compare early and late postoperative clinical outcomes between minimally invasive surgery (MIS) and full sternotomy (FS) in patients undergoing surgery for mitral valve infective endocarditis (IE). The authors conducted the review in compliance with PRISMA guidelines and searched PubMed, Scopus, and Web of Science for randomized controlled trials or cohort studies that directly compared MIS versus FS for mitral valve IE.
The pooled analysis included four cohort studies comprising a total of 466 patients: 137 managed with MIS and 329 managed with FS. No randomized controlled trials were reported in the abstract; all included studies were observational cohort designs. The abstract did not provide further study-level characteristics such as enrollment periods, specific MIS techniques, or detailed baseline patient demographics; those details were not reported in the source abstract.
Pooled effect estimates showed no statistically significant difference between MIS and FS for in-hospital or 30-day mortality: risk ratio (RR) 0.71, 95% confidence interval (CI) 0.31–1.60 (p = 0.40). Similarly, there was no significant difference in stroke (RR 0.63, 95% CI 0.16–2.46; p = 0.50) or postoperative atrial fibrillation (RR 0.89, 95% CI 0.57–1.40; p = 0.62).
These findings indicate comparable early mortality and common neurologic and rhythm complication rates between minimally invasive surgery and median sternotomy in the cohort data included in this meta-analysis.
For renal complications, the pooled analysis found no statistically significant difference in acute kidney injury or renal failure (RR 0.51, 95% CI 0.22–1.16; p = 0.11). Multi-organ failure rates were also similar between approaches (RR 0.94, 95% CI 0.33–2.70; p = 0.90).
By contrast, postoperative sepsis occurred significantly less often in patients who underwent MIS (RR 0.17, 95% CI 0.03–0.84; p = 0.03), according to the pooled cohort data.
The meta-analysis identified significant reductions in some resource-use metrics favoring MIS. Patients in the MIS group required fewer blood transfusions (RR 0.63, 95% CI 0.48–0.84; p = 0.001). Intensive care unit (ICU) length of stay was shorter after MIS with a pooled mean difference reported as -1.57 (95% CI -2.16 to -0.97; p < 0.00001).
Readmission rates did not differ significantly between MIS and FS (RR 0.75, 95% CI 0.39–1.45; p = 0.39).
The pooled estimates demonstrated no significant differences between MIS and FS for need for reoperation or for permanent pacemaker implantation. Mid-term outcomes reported in the abstract also showed no significant difference in survival up to 2.5 years, and no difference in infective endocarditis recurrence up to 3.5 years between the two surgical approaches.
Based on the pooled cohort data, the authors concluded that minimally invasive surgery may be a safe and cost-effective alternative to full sternotomy for patients undergoing surgery for mitral valve infective endocarditis. They emphasized that choice of surgical approach should be individualized according to the patient’s clinical risk profile, the anatomic extent of endocarditis, and the surgical team’s experience to achieve optimal outcomes.
The abstract reports inclusion of four cohort studies but does not provide detailed study-level methods, selection criteria, operative technique descriptions, or the extent of heterogeneity among studies; these specifics were not available in the source abstract. The absence of randomized controlled trials is notable. Information on longer-term outcomes beyond the reported survival and recurrence windows, cost analyses beyond transfusion and ICU stay proxies, and subgroup analyses (for example by organism, prosthetic versus native valve, or severity of infection) were not described in the abstract and therefore cannot be summarized from the source.
Clinicians considering MIS for mitral valve IE should weigh the observed reductions in postoperative sepsis, transfusion requirements, and ICU stay against the need to ensure appropriate patient selection and institutional expertise. Further detailed study-level data and randomized evidence were not reported in the abstract and would be required to strengthen comparative recommendations.