{"id":"c887ac18ecc4","type":"article","url":"https://hartvaat.nl/2026/01/27/minimaal-invasieve-mitralisklepchirurgie-sneller-herstel-even-veilig-als-de-conv/","title":"Minimaal-invasieve mitralisklepchirurgie: sneller herstel, even veilig als de conventionele operatie","title_en":"Minimally invasive versus conventional mitral valve surgery: a systematic review and meta-analysis of randomised clinical trials","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003612?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003612?rss=1","authors":["Spadini","F. A.","Lira","K. B.","Delvaux","R. S.","Kopittke","L.","Anschau","F.","Ceron","R. O.","Rode","J.","Rey","R. A. W.","Almeida","A. S."],"significance":6,"published":"2026-01-27","source_date":"2026-01-27","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/hartgeruisen-herkenning/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-bloeding/"],"congress":"","summary_en":"Whether minimally invasive mitral valve surgery (MIMVS) offers advantages over the conventional approach (CMVS) was controversial. This systematic review and meta-analysis of randomised trials (8 RCTs, 9 studies, 1,248 patients: 686 CMVS, 562 MIMVS) compared short-term outcomes. MIMVS did not differ in mortality or acute kidney injury, with a trend toward fewer wound infections and shorter ICU stay. MIMVS did reduce reoperations for bleeding (RR 0.24) and hospital stay (mean 1.8 days shorter). Operative time was longer but without clinical impact; stroke, infarction, ventilation time and transfusions were comparable. Certainty of evidence was mostly moderate to high. MIMVS thus enhances postoperative recovery — shorter stay, fewer reoperations for bleeding — with safety comparable to conventional surgery.","created":"2026-07-03T10:32:27Z","updated":"2026-07-03T13:31:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Of minimaal-invasieve mitralisklepchirurgie (MIMVS) voordelen biedt boven de conventionele aanpak (CMVS) was omstreden. Deze systematische review en meta-analyse van gerandomiseerde trials (8 RCT's, 9 studies, 1.248 patiënten: 686 CMVS, 562 MIMVS) vergeleek de uitkomsten op korte termijn. MIMVS verschilde niet in sterfte of acute nierschade, met een trend naar minder wondinfecties en kortere IC-opname. MIMVS verminderde wel de heroperaties wegens bloeding (RR 0,24) en de ziekenhuisopnameduur (gemiddeld 1,8 dag korter). De operatietijd was langer, maar zonder klinische gevolgen; beroerte, infarct, beademingsduur en transfusies waren vergelijkbaar. De zekerheid van het bewijs was overwegend matig tot hoog. MIMVS bevordert dus het postoperatieve herstel — kortere opname, minder heroperaties wegens bloeding — met een veiligheid die vergelijkbaar is met de conventionele operatie.","abstract_original":"<sec><st>Background</st>\n<p>The benefits of minimally invasive mitral valve surgery (MIMVS) compared with conventional approaches (CMVS, conventional mitral valve surgery) remain controversial. We conducted a systematic review and meta-analysis to evaluate the short-term benefits between these approaches.</p>\n</sec>\n<sec><st>Objective</st>\n<p>To evaluate the short-term benefits of MIMVS versus CMVS in adults.</p>\n</sec>\n<sec><st>Methods</st>\n<p>We searched PubMed/MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, clinical trial registries and grey literature using MeSH terms, without date or language restrictions. Randomised clinical trials (RCTs) comparing MIMVS and CMVS in adults (&ge;18 years) were included. Robotic, endovascular and redo procedures were excluded. Two reviewers independently extracted data following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Cochrane tool, and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation. Meta-analyses used random-effects models. Primary outcomes were mortality, acute kidney injury (AKI) and wound infection.</p>\n</sec>\n<sec><st>Results</st>\n<p>Nine studies (1248 patients) from eight RCTs were included (686 CMVS, 562 MIMVS). MIMVS showed no significant difference in mortality or AKI compared with CMVS. There was a trend towards fewer wound infections (risk ratio=0.47; 95% CI=0.22 to 1.00) and shorter intensive care unit (ICU) stay (mean difference=&ndash;0.71 days; 95% CI=&ndash;1.47 to 0.04). MIMVS reduced reoperation for bleeding (RR=0.24; 95% CI=0.06 to 0.92) and hospital stay (mean difference=&ndash;1.83 days; 95% CI=&ndash;3.03 to &ndash;0.64). Operative times were longer with MIMVS, but without clinical impact. Stroke, myocardial infarction, mechanical ventilation time and transfusion rates were similar. Most studies had low risk of bias, with moderate to high certainty of evidence. No heterogeneity was detected for primary outcomes.</p>\n</sec>\n<sec><st>Conclusion</st>\n<p>MIMVS enhances postoperative recovery through shorter hospital stays, fewer reoperations for bleeding and a trend towards fewer wound infections and shorter ICU stays compared with CMVS. Despite longer operative times, key safety is comparable between techniques. The overall certainty of evidence is high for most outcomes, supporting strong clinical recommendations in favour of MIMVS.</p>\n</sec>\n<sec><st>PROSPERO registration number</st>\n<p>CRD42022321939.</p>\n</sec>"}