{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:26:59Z","timestamp":1787304419417,"version":"build-2736575974"},"reference-count":51,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With improved cardiac surgical outcomes, attention has shifted to patient-centred outcomes, including cosmetic appearances of surgical scars. Minimally invasive cardiac surgery (MICS) is often promoted for its cosmetic benefits, yet empirical evidence remains limited. This study aimed to systematically evaluate scar-specific outcomes comparing MICS to conventional full median sternotomy (FMS) in adult cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Embase, Central, and Scopus were searched from inception to August 2025. Studies comparing MICS to FMS, reporting scar-related patient-reported outcomes, wound complications, or cosmetic satisfaction, were included. The primary outcome was scar assessment using validated instruments. Random-effects models calculated standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-two studies comprising 3131 patients (1459 MICS, 1672 FMS) met inclusion criteria. MICS demonstrated significantly better scar assessment scores (SMD \u22120.74, 95% CI \u22121.27 to \u22120.22; p &lt; 0.01; I\n                      <jats:sup>2<\/jats:sup>\n                      = 88%, six studies), higher patient satisfaction rates (RR 1.42, 95% CI 1.21\u20131.66; p &lt; 0.001; I\n                      <jats:sup>2<\/jats:sup>\n                      = 84%, 12 studies), and reduced wound complications (RR 0.31, 95% CI 0.20\u20130.47; p &lt; 0.001; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%, nine studies). Only six studies reported validated scar assessment scores, highlighting limited integration of these measures. Substantial heterogeneity was observed due to diverse assessment tools and surgical techniques.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MICS can offer significant advantages in scar-specific outcomes compared to FMS in carefully selected patient populations. Cosmetic outcomes should be interpreted within the context of overall effectiveness and may support shared decision making only when clinical outcomes between surgical approaches are comparable. The lack of standardised scar assessment protocols and limited reporting of cosmetic outcomes represent critical gaps. Future research should prioritise standardised scar evaluation tools and expand cosmetic outcome reporting across all cardiac surgical procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261452059","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:51:52Z","timestamp":1780998712000},"page":"814-828","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Scar-specific outcomes following minimally invasive versus conventional median sternotomy in cardiac surgery: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8061-6237","authenticated-orcid":false,"given":"Karanjot","family":"Chhatwal","sequence":"first","affiliation":[{"name":"Imperial College London"},{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"On Chun Siu","sequence":"additional","affiliation":[{"name":"Royal Berkshire Hospital Foundation Trust, NHS England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1374-5143","authenticated-orcid":false,"given":"Sammy","family":"Arab","sequence":"additional","affiliation":[{"name":"Imperial College London"},{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Salih","sequence":"additional","affiliation":[{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Shah","sequence":"additional","affiliation":[{"name":"University College London Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4931-4049","authenticated-orcid":false,"given":"Arian","family":"Arjomandi Rad","sequence":"additional","affiliation":[{"name":"Oxford University Foundation Trust, NHS England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6147-2900","authenticated-orcid":false,"given":"Gordon Lap Wai","family":"Chong","sequence":"additional","affiliation":[{"name":"University of Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monjur","family":"Showkat","sequence":"additional","affiliation":[{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangeeta","family":"Punjabi","sequence":"additional","affiliation":[{"name":"London North West Hospitals NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Punjabi","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.25083\/2559.5555.11.3340"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13030761"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-20-2213"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.4103\/0971-9784.154463"},{"key":"e_1_3_7_6_2","volume-title":"Death rates from cardiovascular disease have fallen dramatically \u2014 what were the breakthroughs behind this?","author":"Dattani S","year":"2025","unstructured":"Dattani S. Death rates from cardiovascular disease have fallen dramatically \u2014 what were the breakthroughs behind this? Our World Data 2025 Available from. https:\/\/ourworldindata.org\/cardiovascular-deaths-decline"},{"key":"e_1_3_7_7_2","unstructured":"Cleveland C Cleveland Clinic. Cardiothoracic surgical outcomes: what steady improvements add up to over time. Available from. https:\/\/consultqd.clevelandclinic.org\/cardiothoracic-surgical-outcomes-what-steady-improvements-add-up-to-over-time"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.10.004"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/16.Supplement_2.S73"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0000000000001091"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12055-023-01501-y"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.08.227"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000002204"},{"key":"e_1_3_7_14_2","first-page":"e43","article-title":"A review of scar scales and scar measuring devices","volume":"10","author":"Fearmonti R","year":"2010","unstructured":"Fearmonti R, Bond J, Erdmann D, et al. A review of scar scales and scar measuring devices. Eplasty 2010; 10: e43. Available from. https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC2890387\/","journal-title":"Eplasty"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.643098"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14812"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0267659116657166"},{"key":"e_1_3_7_19_2","unstructured":"Ahangar AG Charag AH Wani ML et al. Comparing aortic valve replacement through right anterolateral."},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina54020026"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jescts.2016.08.006"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)00362-8"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)00314-8"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-830422"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-35743"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2041-3695"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jescts.2017.07.001"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-020-01294-w"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-020-01242-8"},{"issue":"13","key":"e_1_3_7_30_2","first-page":"6247","article-title":"Minimally invasive cardiac surgery in low-resource settings: right vertical infra-axillary mini-thoracotomy without peripheral cannulation - the first 100 cases","volume":"27","author":"\u0130star H","year":"2023","unstructured":"\u0130star H, Sevuk U. Minimally invasive cardiac surgery in low-resource settings: right vertical infra-axillary mini-thoracotomy without peripheral cannulation - the first 100 cases. Eur Rev Med Pharmacol Sci 2023; 27(13): 6247\u20136255. https:\/\/doi.org\/10.26355\/eurrev_202307_32984","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2017.01.105"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2019.07.07"},{"key":"e_1_3_7_33_2","first-page":"S11340096250018","article-title":"Conventional or minimally invasive aortic valve replacement: perioperative and 3-year outcomes","author":"Miranda-Torr\u00f3n JM","year":"2025","unstructured":"Miranda-Torr\u00f3n JM, P\u00e9rez-Camargo D, Carnero-Alc\u00e1zar M, et al. Conventional or minimally invasive aortic valve replacement: perioperative and 3-year outcomes. Cir Cardiovasc 2025, S113400962500186X. Available from. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S113400962500186X","journal-title":"Cir Cardiovasc"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.4081\/itjm.2025.1963"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/1556984520956980"},{"key":"e_1_3_7_36_2","article-title":"Minimal invasive aortic valve replacement through right mini_thoracotomy versus conventional approach in the Egypt","author":"Salama AM","year":"2021","unstructured":"Salama AM, Eid A, Adel W, et al. Minimal invasive aortic valve replacement through right mini_thoracotomy versus conventional approach in the Egypt. Sys Rev Pharm 2021, Available from. https:\/\/www.sysrevpharm.org\/abstract\/minimal-invasive-aortic-valve-replacement-through-right-minithoracotomy-versus-conventional-approach-in-the-egypt-66967.html","journal-title":"Sys Rev Pharm"},{"issue":"1","key":"e_1_3_7_37_2","first-page":"15","article-title":"Comparison of right anterolateral thorocotomy with standard median steronotomy for mitral valve replacement","volume":"7","author":"Shah ZA","year":"2013","unstructured":"Shah ZA, Ahangar AG, Ganie FA, et al. Comparison of right anterolateral thorocotomy with standard median steronotomy for mitral valve replacement. Int Cardiovasc Res J 2013; 7(1): 15\u201320.","journal-title":"Int Cardiovasc Res J"},{"key":"e_1_3_7_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivaa276"},{"key":"e_1_3_7_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.14172"},{"issue":"4","key":"e_1_3_7_40_2","first-page":"753","article-title":"The median sternal incision in intracardiac surgery with extracorporeal circulation; a general evaluation of its use in heart surgery","volume":"42","author":"Julian OC","year":"1957","unstructured":"Julian OC, Lopez-Belio M, Dye WS, et al. The median sternal incision in intracardiac surgery with extracorporeal circulation; a general evaluation of its use in heart surgery. Surgery 1957; 42(4): 753\u2013761.","journal-title":"Surgery"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-022-03244-6"},{"key":"e_1_3_7_42_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2022.06.015"},{"key":"e_1_3_7_43_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2021.033"},{"issue":"22","key":"e_1_3_7_44_2","first-page":"3830","article-title":"Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure","volume":"32","author":"Fleisher J","year":"2019","unstructured":"Fleisher J, Khalifeh A, Pettker C, et al. Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 2019; 32(22): 3830\u20133835. https:\/\/doi.org\/10.1080\/14767058.2018.1474870","journal-title":"J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet"},{"key":"e_1_3_7_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-025-04292-x"},{"key":"e_1_3_7_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14373"},{"key":"e_1_3_7_47_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006652"},{"key":"e_1_3_7_48_2","doi-asserted-by":"publisher","DOI":"10.1631\/jzus.B2200036"},{"key":"e_1_3_7_49_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198911000-00021"},{"key":"e_1_3_7_50_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09760-3"},{"key":"e_1_3_7_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.07.057"},{"key":"e_1_3_7_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011424"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261452059","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591261452059","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261452059","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:56:41Z","timestamp":1787302601000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591261452059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":51,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/02676591261452059"],"URL":"https:\/\/doi.org\/10.1177\/02676591261452059","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}