---
title: "Minimally invasive surgery vs median sternotomy for mitral valve infective endocarditis: meta-anal"
id: "pubmed-42723536"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42723536"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42723536/"
doi: "10.1177/02676591261488628"
published_at: "2026-09-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Minimally invasive surgery vs median sternotomy for mitral valve infective endocarditis: meta-anal
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42723536
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42723536/)
- **DOI:** [10.1177/02676591261488628](https://doi.org/10.1177%2F02676591261488628)
- **Published At:** 2026-09-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This meta-analysis compared **minimally invasive surgery (MIS)** with **full sternotomy (FS)** for patients undergoing surgery for **mitral valve infective endocarditis (IE)**, following PRISMA methods and searching PubMed, Scopus, and Web of Science. - Four cohort studies totaling 466 patients were included: 137 in the MIS group and 329 in the FS group. - No randomized controlled trials were identified in the source abstract; included studies were cohort designs. - Primary pooled outcomes showed no statistically significant difference between MIS and FS for in-hospital/30-day mortality (RR 0.71, 95% CI 0.31–1.60; p=0.40). - No significant differences were found for stroke (RR 0.63, 95% CI 0.16–2.46; p=0.50), atrial fibrillation (RR 0.89, 95% CI 0.57–1.40; p=0.62), acute kidney injury/renal failure (RR 0.51, 95% CI 0.22–1.16; p=0.11), multi-organ failure (RR 0.94, 95% CI 0.33–2.70; p=0.90), or readmission rates (RR 0.75, 95% CI 0.39–1.45; p=0.39). - MIS was associated with significantly lower postoperative sepsis (RR 0.17, 95% CI 0.03–0.84; p=0.03), fewer blood transfusions (RR 0.63, 95% CI 0.48–0.84; p=0.001), and shorter ICU stay (mean difference RR = -1.57, 95% CI -2.16 to -0.97; p<0.00001) compared with FS. - There were no significant differences in need for reoperation, permanent pacemaker implantation, survival up to 2.5 years, or infective endocarditis recurrence up to 3.5 years between approaches. - Authors conclude MIS may be a safe and cost-effective alternative to FS for mitral valve IE, but recommend tailoring the surgical approach to the patient’s clinical risk, extent of infection, and team experience. - Study- and patient-level details (for example study inclusion criteria, operative techniques, or long-term follow-up methods) were not reported in the abstract and therefore are not available from the source.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Minimally invasive approach versus median sternotomy in patients undergoing surgery for mitral valve infective endocarditis, a meta-analysis [Karam R Motawea](https://pubmed.ncbi.nlm.nih.gov/?term=Motawea+KR&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Michael Blackledge](https://pubmed.ncbi.nlm.nih.gov/?term=Blackledge+M&cauthor_id=42723536)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-2 "Division of Cardiac Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA."), [Abed M Al-Sheikh](https://pubmed.ncbi.nlm.nih.gov/?term=Al-Sheikh+AM&cauthor_id=42723536)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-2 "Division of Cardiac Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA."), [Mohammad El Diasty](https://pubmed.ncbi.nlm.nih.gov/?term=El+Diasty+M&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Yakov Elgudin](https://pubmed.ncbi.nlm.nih.gov/?term=Elgudin+Y&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Joseph F Sabik 3rd](https://pubmed.ncbi.nlm.nih.gov/?term=Sabik+JF+3rd&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Yasir Abu-Omar](https://pubmed.ncbi.nlm.nih.gov/?term=Abu-Omar+Y&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#full-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.") Affiliations Expand ### Affiliations * 1 Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. * 2 Division of Cardiac Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA. * PMID: **42723536** * DOI: [ 10.1177/02676591261488628 ](https://doi.org/10.1177/02676591261488628) Item in Clipboard # Minimally invasive approach versus median sternotomy in patients undergoing surgery for mitral valve infective endocarditis, a meta-analysis Karam R Motawea et al. Perfusion. 2026. Show details Display options Display options Format Abstract PubMed PMID Perfusion Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Perfusion%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Perfusion%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42723536/) . 2026 Sep 11:2676591261488628. doi: 10.1177/02676591261488628. Online ahead of print. ### Authors [Karam R Motawea](https://pubmed.ncbi.nlm.nih.gov/?term=Motawea+KR&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Michael Blackledge](https://pubmed.ncbi.nlm.nih.gov/?term=Blackledge+M&cauthor_id=42723536)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-2 "Division of Cardiac Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA."), [Abed M Al-Sheikh](https://pubmed.ncbi.nlm.nih.gov/?term=Al-Sheikh+AM&cauthor_id=42723536)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-2 "Division of Cardiac Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA."), [Mohammad El Diasty](https://pubmed.ncbi.nlm.nih.gov/?term=El+Diasty+M&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Yakov Elgudin](https://pubmed.ncbi.nlm.nih.gov/?term=Elgudin+Y&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Joseph F Sabik 3rd](https://pubmed.ncbi.nlm.nih.gov/?term=Sabik+JF+3rd&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA."), [Yasir Abu-Omar](https://pubmed.ncbi.nlm.nih.gov/?term=Abu-Omar+Y&cauthor_id=42723536)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723536/#short-view-affiliation-1 "Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.") ### Affiliations * 1 Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. * 2 Division of Cardiac Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA. * PMID: **42723536** * DOI: [ 10.1177/02676591261488628 ](https://doi.org/10.1177/02676591261488628) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract ObjectiveWe aimed to compare early and late postoperative clinical outcomes between minimally invasive surgery (MIS) and full sternotomy (FS) in patients with mitral valve (MV) infective endocarditis (IE).MethodsThis meta-analysis was conducted in compliance with the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched for any randomized control trials or cohort studies that compared MIS versus FS in surgery for mitral valve infective endocarditis.ResultsFour cohort studies with 466 patients (137 in MIS group and 329 in FS group), were included in our study. Pooled analysis showed no significant difference between MIS and FS in terms of in-hospital/30-day mortality (RR = 0.71, 95% CI [0.31-1.60], _p_ -value = 0.40), stroke (RR = 0.63, 95% CI [0.16-2.46], _p_ -value = 0.50), atrial fibrillation (RR = 0.89, 95% CI [0.57-1.40], _p_ -value = 0.62), acute kidney injury/renal failure (RR = 0.51, 95% CI [0.22-1.16], _p_ -value = 0.11), multi-organ failure (RR = 0.94, 95% CI [0.33-2.70], _p_ -value = 0.90), and readmission rates (RR = 0.75, 95% CI [0.39-1.45], _p_ -value = 0.39). However, our study showed a statistically significant association between MIS and lower risk of postoperative sepsis (RR = 0.17, 95% CI [0.03-0.84], _p_ -value = 0.03), fewer blood transfusions (RR = 0.63, 95% CI [0.48-0.84], _p_ -value = 0.001), and shorter length of ICU stay (RR = -1.57, 95% CI [-2.16, -0.97], _p_ -value <0.00001) compared to FS. The pooled effect estimate showed no significant difference between both groups in terms of need for reoperation, permanent pacemaker implantation, survival up to 2.5 years, and IE recurrence up to 3.5 years.ConclusionsOur findings suggest that MIS may be a safe and cost-effective alternative for FS in patients undergoing surgery for mitral valve infective endocarditis. Surgical approach should be tailored to the patient's clinical risk profile, the extent of endocarditis, and the team's experience, to ensure optimal clinical outcomes. **Keywords:** infective endocarditis; median sternotomy; minimally invasive surgery; mitral valve. 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