{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T21:29:40Z","timestamp":1788643780092,"version":"build-2803163510"},"reference-count":33,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001659","name":"deutsche forschungsgemeinschaft","doi-asserted-by":"publisher","award":["413668513"],"award-info":[{"award-number":["413668513"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005971","name":"deutsche herzstiftung","doi-asserted-by":"publisher","award":["S\/03\/23"],"award-info":[{"award-number":["S\/03\/23"]}],"id":[{"id":"10.13039\/501100005971","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Interdisciplinary Center of Clinical Research, Medical Faculty Jena"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Innovations\ufffd(Phila)"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Minimally invasive cardiac surgery for mitral valve (MV) disease is a rising strategy. Axillary access is linked to reduced pain and faster recovery, but its efficacy and safety compared with median sternotomy for MV surgery (MVS) remain unclear. We conducted a meta-analysis comparing the clinical outcomes of MVS via axillary access and median sternotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Four databases were analyzed. The primary endpoint was perioperative mortality. Secondary endpoints included cardiopulmonary bypass (CPB) and cross-clamp times, rethoracotomy, wound complications, mechanical ventilation duration, stroke, hospital and intensive care unit (ICU) stay, and residual moderate mitral regurgitation. A random-effects model was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We included 2,129 patients from 4 studies, with 1,135 (53.3%) undergoing axillary access. Perioperative mortality was comparable between approaches (odds ratio [OR] = 0.34, 95% confidence interval [CI]: 0.09 to 1.23,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.10). Axillary access was associated with longer CPB times (mean difference [MD] = 16.38, 95% CI: 6.42 to 26.34,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001), fewer wound complications (OR = 0.41, 95% CI: 0.21 to 0.80,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.009), shorter ventilation time (MD = \u22124.93, 95% CI: \u22128.79 to \u22121.08,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01), and shorter hospital (MD = \u22120.78, 95% CI: \u22121.41 to \u22120.14,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02) and ICU stays (MD = \u221210.84, 95% CI: \u221219.54 to \u22122.14,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01). No difference was found in cross-clamp time, rethoracotomy, stroke, or residual mitral regurgitation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Axillary access for MVS shows comparable mortality to median sternotomy, with benefits in wound complications, ventilation, and recovery but longer CPB times. Further research is needed to confirm long-term safety and efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15569845251400765","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T05:06:06Z","timestamp":1769576766000},"page":"28-36","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Axillary Versus Sternotomy Access in Minimally Invasive Mitral Valve Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8407-1731","authenticated-orcid":false,"given":"Abdullah","family":"Almehandi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Science, University College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Ramadhan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jaber Al Ahmad Al Jaber Al Sabah Hospital, Surra, Al Asimah Governorate, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Ali","sequence":"additional","affiliation":[{"name":"Faculty of Life Science and Medicine, Kings College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Almhanedi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jaber Al Ahmad Al Jaber Al Sabah Hospital, Surra, Al Asimah Governorate, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman Osama","family":"Al-Naseem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jaber Al Ahmad Al Jaber Al Sabah Hospital, Surra, Al Asimah Governorate, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Gonnah","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6647-1866","authenticated-orcid":false,"given":"Ahmad","family":"Awad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hristo","family":"Kirov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Doenst","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakan I.","family":"Nazer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Science, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5697-2659","authenticated-orcid":false,"given":"Tulio","family":"Caldonazo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany"},{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-021-02121-3"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-021-01578-9"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.23736\/S0021-9509.16.09603-8"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.08.050"},{"key":"e_1_3_2_6_2","first-page":"693","article-title":"A meta-analysis of minimally invasive versus conventional mitral valve repair for patients with degenerative mitral disease","volume":"2","author":"Cao C","year":"2013","unstructured":"Cao C, Gupta S, Chandrakumar D, et al. A meta-analysis of minimally invasive versus conventional mitral valve repair for patients with degenerative mitral disease. 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ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. 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First case (mitral valvuloplasty) operated with success [in French]","volume":"319","author":"Carpentier A","year":"1996","unstructured":"Carpentier A, Loulmet D, Carpentier A, et al. Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success [in French]. C R Acad Sci III 1996; 319: 219\u2013223.","journal-title":"C R Acad Sci III"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1754353"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12055-018-0672-9"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-021-01844-9"},{"key":"e_1_3_2_32_2","article-title":"Minimally invasive valve surgery in high-risk patients","volume":"9","author":"Santana O","year":"2017","unstructured":"Santana O, Xydas S, Williams RF, et al. Minimally invasive valve surgery in high-risk patients. 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