{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:53:00Z","timestamp":1791355980727,"version":"4.3.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Redo mitral valve surgery carries substantial risk, and the relative benefits of minimally invasive (MI\u2010MVS) versus sternotomy MVS, particularly regarding long\u2010term survival, remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Electronic databases were searched for studies comparing MI\u2010MVS with sternotomy MVS in adult redo MVS. Kaplan\u2013Meier curves were digitized to reconstruct individual patient data for time\u2010to\u2010event analysis, with study\u2010level hazard ratios (HR) generated using a Cox frailty model. Perioperative outcomes were pooled using random\u2010effects models. Subgroup analyses evaluated propensity\u2010matched cohorts, endoscopic\/video\u2010assisted minithoracotomy, and direct\u2010vision minithoracotomy. Meta\u2010regression explored the impact of study\u2010level covariates on mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Fifteen studies including 3457 patients were analyzed. MI\u2010MVS was associated with lower perioperative mortality compared with sternotomy MVS (odds ratio [OR], 0.33 [95% CI, 0.23\u20130.48];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), reduced incidence of reoperation (OR, 0.65 [95% CI, 0.44\u20130.98];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.04), and acute kidney injury (OR, 0.58 [95% CI, 0.39\u20130.87];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008); rates of stroke and arrhythmia were similar. The direction and magnitude of the mortality effect consistently favored MI\u2010MVS in the subgroup analyses. Time\u2010to\u2010event analysis demonstrated improved survival with MI\u2010MVS (HR, 0.74 [95% CI, 0.62\u20130.89];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.001), but this was attenuated in the propensity\u2010matched analysis. Meta\u2010regression showed that sex distribution, mean age, and baseline left ventricular ejection fraction did not significantly moderate mortality effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In redo MVS, MI\u2010MVS is associated with improved perioperative outcomes without compromising long\u2010term survival; however, attenuation of the survival difference after propensity matching suggests that this long\u2010term advantage may reflect baseline risk rather than procedural effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.050284","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:23:51Z","timestamp":1791354231000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Minimally Invasive Versus Sternotomy in Redo Mitral Valve Surgery: Short\u2010 and Long\u2010Term Outcomes with Meta\u2010Regression and Time\u2010to\u2010Event Analysis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3563-4211","authenticated-orcid":false,"given":"Kristine","family":"Santos","sequence":"first","affiliation":[{"name":"New Vision University School of Medicine","place":["Tbilisi, Georgia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0793-2056","authenticated-orcid":false,"given":"Joo Y. B.","family":"Kim Kim","sequence":"additional","affiliation":[{"name":"Universidad Nacional de Asunci\u00f3n","place":["Asunci\u00f3n, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1393-7671","authenticated-orcid":false,"given":"Neel","family":"Patel","sequence":"additional","affiliation":[{"name":"New Vision University School of Medicine","place":["Tbilisi, Georgia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halima","family":"\u015eah","sequence":"additional","affiliation":[{"name":"Bah\u00e7e\u015fehir University","place":["Istanbul, Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-8635","authenticated-orcid":false,"given":"Sriharsha","family":"Koduru","sequence":"additional","affiliation":[{"name":"Jawaharlal Institute of Postgraduate Medical Education and Research","place":["Pondicherry, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Napoli","sequence":"additional","affiliation":[{"name":"Heart, Thoracic & Vascular Institute; Cleveland Clinic Florida","place":["Weston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-324X","authenticated-orcid":false,"given":"Nicolas A.","family":"Brozzi","sequence":"additional","affiliation":[{"name":"Heart, Thoracic & Vascular Institute; Cleveland Clinic Florida","place":["Weston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4089-2202","authenticated-orcid":false,"given":"Jose L.","family":"Navia","sequence":"additional","affiliation":[{"name":"Heart, Thoracic & Vascular Institute; Cleveland Clinic Florida","place":["Weston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Polanco","sequence":"additional","affiliation":[{"name":"Heart, Thoracic & Vascular Institute; Cleveland Clinic Florida","place":["Weston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5356-2996","authenticated-orcid":false,"given":"Michel Pompeu","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"Heart, Thoracic & Vascular Institute; Cleveland Clinic Florida","place":["Weston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivae042"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8191.2001.tb01214.x"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Burfeind WR Glower DD Davis RD Landolfo KP Lowe JE Wolfe WG. 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