September 17, 2025

Partial upper sternotomy vs full median sternotomy in obese patients undergoing aortic valve replacement: A meta-analysis

Key Points

Partial upper sternotomy reduced intensive care unit stay by 2.67 days, while increasing cardiopulmonary bypass time by 5.62 minutes.
A meta-analysis of four studies involving 677 obese patients found no significant difference in renal failure or atrial fibrillation rates between surgical approaches.
The study adhered to PRISMA guidelines, assessing outcomes using odds ratios and mean differences from various databases for comprehensive analysis.
This analysis highlights the efficacy of partial upper sternotomy for obese patients undergoing aortic valve replacement, emphasizing the need for surgical expertise.

Abstract

BACKGROUND Obese patients (body mass index ≥ 30 kg/m²) undergoing isolated aortic valve replacement (AVR) face increased surgical risks due to comorbidities. Partial upper sternotomy (PUS), a minimally invasive approach, may reduce complications compared to full median sternotomy (FMS). We hypothesize that PUS improves outcomes over FMS in obese patients undergoing AVR. AIM To compare the efficacy and safety of PUS vs FMS in obese patients undergoing isolated AVR. METHODS This systematic review and meta-analysis followed PRISMA guidelines, searching PubMed, EMBASE, and Cochrane databases for observational studies comparing PUS vs FMS in obese patients undergoing AVR. Outcomes were analyzed using odds ratios (OR), mean differences (MD), 95% confidence intervals (CI), I ² statistic, and Newcastle-Ottawa Scale was used for quality assessment. RESULTS Four observational studies involving 677 patients were analyzed. PUS reduced intensive care unit stay (MD -2.67 days, 95%CI: -4.43 to -0.90, P = 0.003, I ² = 78%) but increased cardiopulmonary bypass time (MD 5.62 minutes, 95%CI: -0.36 to 11.59, I ² = 55%). No differences were observed in renal failure (OR 1.13, 95%CI: 0.63-2.94, I ² = 0%), atrial fibrillation (OR 0.81, 95%CI: 0.43-1.54, I ² = 30%), reexploration (OR 1.09, 95%CI: 0.48-2.47, I ² = 0%), postoperative bleeding (OR 1.48, 95%CI: 0.53-4.15, I ² = 60%), wound infection (OR 1.23, 95%CI: 0.70-2.14, I ² = 0%), hospital stay (MD 0.51 days, 95%CI: -4.13 to 5.15, I ² = 90%), or cross-clamp time (MD 4.03 minutes, 95%CI: -0.75 to 8.80, I ² = 50%). CONCLUSION PUS is safe and effective for obese patients undergoing AVR, reducing intensive care unit stay and enhancing recovery, provided surgical expertise is available.

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