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

doi:10.4330/wjc.v17.i9.110838

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis

World J Cardiol. Sep 26, 2025; 17(9): 110838
Published online Sep 26, 2025. doi: 10.4330/wjc.v17.i9.110838

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

Aarushi Gupta, Tinatin Chikhradze, Afrah Arshad, Rahmah Ashar Sakrani, Zainab Khan, Melake Getahun, Samreen Rizwan Ahmed Shaikh, Wajiha Syed, Tanish Baweja, Abhijith Remesan, Cheryl Lewis, Joy Doshi, Muneeb Khawar, Asraf Hussain, Muhammad Muneeb Khawar

Aarushi Gupta, Zainab Khan, Department of Cardiology, Avalon University School of Medicine, Willemstad 4797, Netherlands

Tinatin Chikhradze, Cheryl Lewis, Department of Cardiology, Tbilisi State Medical University, Tbilisi 0144, Georgia

Afrah Arshad, Department of Medicine, Medway Maritime Hospital NHS Foundation Trust, Gillingham ME7 5NY, United Kingdom

Rahmah Ashar Sakrani, Department of Cardiology, Dow International Medical College, Karachi 05444, Sindh, Pakistan

Melake Getahun, Department of Cardiology, University of Gondar, Adama 1200, Ethiopia

Samreen Rizwan Ahmed Shaikh, Department of Cardiology, Ivane Javakhishvili Tbilisi State University, Tbilisi 0144, Georgia

Wajiha Syed, Muneeb Khawar, Muhammad Muneeb Khawar, Department of Cardiology, King Edward Medical University, Lahore 05450, Punjab, Pakistan

Tanish Baweja, Department of Cardiology, Hamdard Institute of Medical Sciences and Research, New Delhi 110001, Delhi, India

Abhijith Remesan, Department of Cardiology, St Martinus University, Willemstad 4797, Netherlands

Joy Doshi, Department of Cardiology, University Hospital Lewisham, London NW1, United Kingdom

Muneeb Khawar, Department of Medicine, King Edward Medical University, Lahore 05450, Punjab, Pakistan

Asraf Hussain, Department of Cardiology, Chitwan Medical College, Bharatpur 33915, Nepal

Co-first authors: Aarushi Gupta and Tinatin Chikhradze.

Author contributions: Gupta A, Arshad A, Sakrani RA, Khan Z, Getahun M, Shaikh SRA, and Syed W performed the data extraction; Baweja T, Remesan A, and Lewis C contributed to data analysis tools and quality assessment; Chikhradze T, Doshi J, Khawar M, Hussain A, and Khawar MM analyzed the data; Gupta A, Chikhradze T, Arshad A, and Khawar MM wrote the manuscript; All authors designed the research study. All authors have read and approved the final manuscript. Gupta A and Chikhradze T contributed equally to this work as co-first authors.

Conflict-of-interest statement: The authors disclose that they have no conflict of interest related to the subject of this study.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Asraf Hussain, MD, Department of Cardiology, Chitwan Medical College, Bharatpur-10, Chitwan, Bharatpur 33915, Nepal. drasrafcardiology@gmail.com

Received: June 17, 2025
Revised: June 25, 2025
Accepted: August 15, 2025
Published online: September 26, 2025
Processing time: 92 Days and 18.5 Hours

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), I² 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, I² = 78%) but increased cardiopulmonary bypass time (MD 5.62 minutes, 95%CI: -0.36 to 11.59, I² = 55%). No differences were observed in renal failure (OR 1.13, 95%CI: 0.63-2.94, I² = 0%), atrial fibrillation (OR 0.81, 95%CI: 0.43-1.54, I² = 30%), reexploration (OR 1.09, 95%CI: 0.48-2.47, I² = 0%), postoperative bleeding (OR 1.48, 95%CI: 0.53-4.15, I² = 60%), wound infection (OR 1.23, 95%CI: 0.70-2.14, I² = 0%), hospital stay (MD 0.51 days, 95%CI: -4.13 to 5.15, I² = 90%), or cross-clamp time (MD 4.03 minutes, 95%CI: -0.75 to 8.80, I² = 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.

Keywords: Partial upper sternotomy; Full median sternotomy; Aortic valve replacement; Obesity; Intensive care unit stay; Cardiopulmonary bypass time; Minimally invasive surgery; Postoperative complications

Core Tip: This meta-analysis innovatively demonstrates that partial upper sternotomy (PUS) is a safe and effective alternative to full median sternotomy for obese patients (body mass index ≥ 30 kg/m²) undergoing aortic valve replacement, uniquely reducing intensive care unit stay by approximately 2.67 days. Despite a trend toward longer cardiopulmonary bypass times, PUS maintains equivalent safety profiles across major complications, offering a compelling minimally invasive option to enhance recovery in this high-risk population.