Trial reportBMJ open2021
Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial.
Trial report in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Minimally invasive versus full sternotomy for combined aortic valve and proximal aortic surgery: a systematic review and meta-analysis.Journal of cardiothoracic surgery · 2026Pooled it
- Limited versus full sternotomy for aortic valve replacement.The Cochrane database of systematic reviews · 2023Pooled it
- Bleeding in minimally invasive versus conventional aortic valve replacement.Journal of cardiothoracic surgery · 2024Trial
- Early outcomes and resource utilization across contemporary transcatheter and surgical valve interventions: a single-center observational study.BMC research notes · 2026Observational
- Cardioplegia Strategies in Minimally Invasive Aortic Valve Replacement: An Inverse Probability of Treatment Weighting Analysis.Medicina (Kaunas, Lithuania) · 2026Article
- Individualized Selection of Valve Intervention Strategies in Aortic Disease Is Key for Better Outcomes.Journal of personalized medicine · 2025Review
- 2024 EACTS/EACTAIC Guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- 2024 EACTS/EACTAIC Guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- Minimally invasive aortic valve replacement in morbidly obese patients: outcomes from a cohort study and pooled data analysis.Frontiers in cardiovascular medicine · 2025Article
- Early Outcomes of Minimally Invasive Right Anterior Thoracotomy vs. Median Full Sternotomy in Isolated Aortic Valve Replacement: A Propensity Score Analysis.Brazilian journal of cardiovascular surgery · 2024Observational
- Is There a Future for Minimal Access and Robots in Cardiac Surgery?Journal of cardiovascular development and disease · 2023Review
- Minimal Access Aortic Valve Surgery.Journal of cardiovascular development and disease · 2023Review
- Economic Justification Analysis of Minimally Invasive versus Conventional Aortic Valve Replacement.International journal of environmental research and public health · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care).
designA single-blind, randomised controlled trial.
settingSingle centre UK National Health Service tertiary hospital.
participantsAdult patients undergoing aortic valve replacement (AVR) surgery.
interventionsIntervention was manubrium-limited mini-sternotomy performed using a 5-7 cm midline incision. Usual care was median sternotomy performed using a midline incision from the sternal notch to the xiphisternum. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the proportion of patients who received a red cell transfusion postoperatively and within 7 days of index surgery. Secondary outcomes included proportion of patients receiving a non-red cell blood component transfusion and number of units transfused within 7 days and during index hospital stay, quality of life and cost-effectiveness analyses.
results270 patients were randomised, received surgery and contributed to the intention to treat analysis. No difference between mini and conventional sternotomy in red-cell transfusion within 7 days was found; 23/135 patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0) and risk difference 0.0 (95% CI -0.1 to 0.1). Mini-sternotomy reduced chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306·9 mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size and postoperative valve function were comparable between mini-sternotomy and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp times (64.1 min (SD 17.1) vs 46·3 min (SD 10.7)). Conventional sternotomy was more cost-effective with only a 5.8% probability of mini-sternotomy being cost-effective at a willingness to pay of £20 000/QALY (Quality Adjusted Life Years).
conclusionsAVR via mini-sternotomy did not reduce red blood cell transfusion within 7 days following surgery when compared with conventional sternotomy. TRIAL REGISTRATION NUMBER: ISRCTN29567910; Results.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.